KEN78 THE ROYAL BOROUGH OF KENSINGTON AND CHELSEA ANNUAL REPORT ON THE HEALTH AND WELFARE OF THE BOROUGH FOR THE YEAR 1969 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 1969 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. 10th July, 1970 To: The Mayor, Aldermen and Councillors of the Royal Borough of Kensington and Chelsea. My Lord, Ladies and Gentlemen, I have the honour to submit my Report on the public health and welfare in Kensington and Chelsea for 1969. This is my last annual report as Director of Health and Social Services, It is the fifth since the Council became responsible for these services and includes the school health service, for which I act for the Inner London Education Authority as principal school medical officer. Population The population estimated by the Registrar-General is 208,480 and compares with 210,720 in 1968. Birth Rate The number of live births per 1,000 population of the borough was 12.3 which compares with 13.9 in the previous year. Death Rate The number of deaths per 1,000 population in 1969 was 10.4 and compares with 10.6 in the previous year. Area Comparability Factors for Births 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 areas by sex and age. 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.). - 2- The Registrar-General has supplied, for use in Kensington and Chelsea in 1969, the figures 0.60 for births and 0.97 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 1969:- Kensington & Chelsea adjusted Inner London Greater London England and Wales No. of births per 1,000 population 7.4 15.7 15.7 16.3 No. of deaths per 1,000 population 10.1 11.9 11.5 11.9 Infant Death Rate This rate for 1969 was 18 as in the previous year. The rate for Greater London was 18.6 and for England and Wales, 18.0. Maternal Death Rate No maternal deaths were recorded in 1969. At their present low level little significance can be attached to maternal death rates except in the general sense. Infectious Diseases There were no specially noteworthy cases of infectious disease but the borough shared with other London boroughs in the widespread prevalence of infections connected with food that was experienced during the long summer. Mental Health The drop in the total number of referrals continued although the total number (1,291) was greater than in 1968 (1,268) but remained lower than in 1967 (1,447). The number of cases in community care at the end of the year, 787, was the highest reached so far and was largely attributable to the small number of withdrawals during the year (189 as against 280 in I968). I have spent most of my professional life in the Public Health Service in pursuance of the elementary axiom that Prevention is better than cure. Over the 40 years many of the diseases have been successfully prevented or reduced. For example, when I commenced my local government service in 1929 the deaths from infectious diseases in England and Wales were as shown in Column 2 of the following Table 1:- 3 Table 1 Causes of Death 1929 Registrar General's Annual Report 1968 * All causes 532,492 576,754 Enteric fever 382 4 Smallpox 39 0 Measles 3,388 51 Scarlet fever 717 5 Pertussis 6,332 15 Diphtheria 3,446 l Erysipelas 1,031 4 Acute poliomyelitis 140 0 Respiratory tuberculosis 31,425 2,912 Puerperal sepsis 1,157 6 Column 3 shows the dramatic reduction as indicated by the latest figures available in the Registrar General's Annual Report for 1968. Locally, the more outstanding reductions in infectious disease deaths are shown in Table 2. Table 2 Kensington & Chelsea 1929 1969 Total deaths 3,691 2,170 Pertussis 77 0 Diphtheria 14 0 Influenza 227 12 Respiratory tuberculosis 165 2 Other tuberculosis 26 3 Puerperal sepsis 13 0 Other Accidents of Pregnancy and Parturition 10 0 Enteritis and Diarrhoea 69 (51 under 1 year) 0 During this period the Infant Mortality Rate has been reduced nationally from 74 to 18.3 per 1,000 live births and locally from 81 to 18. *The figures in this column and those marked with an asterisk lower in the text appear by courtesy of the Registrar General to whom grateful acknowledgement is made. 4 This reduced mortality from infectious disease together with the associated decline in maternal and infant mortality and advances in treatment has produced an overall increased expectation of life. Whereas in 1929 the expectation at birth was 58 years for males and 62 years for females, in 1968 this was 68.6 and 74.8 respectively. Inevitably this has led to an increase in deaths from malignant and degenerative diseases such as:- 1929 1968 Cancer 56,896 102,531 Cerebral haemorrhage 25,215 80,352 Heart diseases 96,467 138,617 Even so, many of these diseases are preventable - e.g. those due to lung cancer and cervical cancer. In fact, there are still tens of thousands of deaths very largely preventible - deaths from the following causes:- 1968 Lung Cancer 28,836 Bronehit is 29,864 Alcoholism 80* Road Traffic Accidents 6,349 Home Accidents 6,6l4* Drug Addiction 30* Suicide 4,586 There are also large numbers of deaths from cardiac disease and other causes predisposed to by overweight. There is also much avoidable illness - venereal disease, urethritis, abortions and their consequences, and unwanted pregnancies. Over the years the emphasis in preventive medicine has changed from "them" to "us". As Sir George Godber, the Chief Medical Officer of the Department of Health and Social Security pointed out in his Inaugural Address to the Royal Society of Health Congress in April, 1970: "A hundred years ago it was pollution - of water supplies, of rivers the insanitation of urban environments, typhoid fever, and the aftermath of the great cholera epidemics. Today the wheel has turned full circle and we are again looking at environmental hazards. This time, however, the principal accent is on the dangers of long-term exposure to chemicals which we ourselves have added to our surroundings." Whereas prevention in byegone days was largely a matter for authority to intervene by such action as environmental and sanitary improvements, disinfection, isolation, quarantine and immunisation, we are now concerned with such man-made hazards as pollution of the air by smoke, flue gases and motor vehicle fumes; pollution of water by factories, pesticides, chemical fertilisers, sewage effluents and toxic substances; pollution of food by pesticides, food additives and antibiotics in animal feeding; and pollution of the lungs by cigarette smoke. As Sir George Godber has written:- "It is a fantastic situation that we promote by our own voluntary - and surely no longer ignorant - actions by far the largest single avoidable cause of death and disability in Britain today. There is no other agent in our environment that approaches the cigarette in menace to health and life." Preventive medicine has now very largely become a matter for the individual's own efforts, directed against cigarette smoking, drugs, over-eating, under-exercising, over-drinking, dangerous driving, and pollution of the atmosphere. There has also been a great alteration in social conditions. I well recall the Depression of the 1920's and early 1930's with the extreme poverty in industrial areas - shoeless, ragged and undernourished children, clinics issuing free milk vouchers for mothers and 5 children, and widespread unemployment with practically none of the benefits now available under the Welfare State. We are now suffering from a permissive society, lawlessness, student and industrial unrest, the abuse of social and educational benefits, road accidents, drug addiction, and a plethora of planners. What work is there to be done? How and by whom, and where is it going to be done? Because of the shift from "them" to "us" there is a clear indication of the need to expand health education - to inform and to educate people how they must accept their personal responsibility in the pursuit of physical, mental and social health. There must be a positive approach to health. They must be educated not to throw health away. There will have to be an end to shrinking from discipline as evidenced by the permissive society, laziness, meretricious pseudo-philosophy justifying unwashed, unwanted workshys and hooligans. There must be a cessation of shelving and disclaiming responsibility in the hope of peace at any price and anything for a quiet life. There will have to be an acceptance of health discipline personally, and by parents, teachers, those responsible for enforcing the law and their supporters. Health education will be necessary to ensure continence of behaviour, appetites and pleasures - for example, in connection with alcoholism and drugs. In this regard the estimates of alcholism in Britain range from 1.1 to 11 per thousand, age 20 and over, and in addition to 1,100 heroin addicts still under treatment there is a much more widespread misuse of amphetamines. Indeed, prescriptions of drugs affecting the mood exceed 30 millions a year. At the moment the emphasis is on "welfare"; trying to sort out the social, mental and moral problems and tragedies of normal and abnormal individuals; problem families, victims of the permissive society; drug addicts, drop outs, handicapped people, children suffering from or causing suffering to their parents; and old age. But in this modern preoccupation with salvaging welfare situations, sight must not be lost of the fundamental preventive principles and services on which the existing Public Health Services have been painstakingly developed over the past century and a quarter: the fundamental essentials of environmental and occupational health - drainage, sanitation, good housing, cleanliness, including that of the atmosphere; pure and nutritious food and drink; infectious disease control; immunisation against 7 or 8 diseases; maternity and child welfare; the health of the school child; rodent and pest control; and health education. These things ore essentially preventive, long term, unspectacular and do not produce rapid or dramatic solutions. Over the years they have come to be taken for granted, but the need for them still continues. Indeed the emphasis on prevention will have to be increased as a result of the economic pressure from the continuing rise in the cost of curative care. In this connection pressing projects for the preventive medical services of the future include a comprehensive occupational health service, the prevention of genetic defects, health checks and the computerisation of records. The Local Authority Social Services Act divorces welfare from medicine, puts it in charge of a lay Director of Social Services and attempts to fragment the Public Health Services into those with an allegedly social slant and those with medical emphasis. The second Green Paper on the National Health Service, adopting the reform of local government boundaries, divorces personal and school health from local authorities and places these services together with the hospital and general practitioner services, under the control of Area Health Authorities, with negligible accountability to local authorities. It is proposed that there shall be about 90 Area Health Authorities in the main coterminous with the Unitary or Metropolitan District Authorities suggested in the proposals for the Reform of Local Government. These latter Authorities will be providing the social services 6 and the environmental health services. The Area Health Authority services will be under the control of a "Community Physician", possibly recruited from the hospital services and working in unspecified headquarters. If local proposals eventuate, it appears that the local authority personal and school health services will have an infinitesimal percentage of the annual budget. In the projected area there will be 34 hospitals - 7 of them teaching schools and 21 subsidiary teaching schools - and 500 general practitioners. The current net expenditure on personal and school health of roughly £750,000 per annum will be insignificant in comparison with the proportion of the budget for the practitioner services (which will be in the neighbourhood of £6,250,000), and that for the 34 hospitals, among which one teaching hospital alone has a future estimated revenue cost of £6,500,000. My views on these proposals are contained in the memorandum which I submitted to the Council Working Party on the Green Paper and the Local Authority Social Services Bill on 2nd April, 1970. They may be summarised by saying that the Green Paper does not deal with the real defects in the National Health Service and the measures it suggests would not effect a remedy. The expensive administrative chaos which would result from these undemocratic and revolutionary proposals would be disruptive to the organisation and discouraging to the recruitment and retention of local authority staff. It should be possible by a continuation of the evolution at present proceeding in the Service to solve all its defects, always providing that the necessary money were forthcoming. It has been a privilege and honour to work for twenty-one years in two Boroughs, now conjoined, which in the present century have contributed so much to the health of the nation with so many pioneering ventures. There have been such institutions as the Violet Melchett Centre, Princess Louise Hospital, the Archer Street Infant Welfare Centre, and Queen Elizabeth College. The last, originally established in Kensington Square in 1908 as the Home Science Department of the King's College for Women, was founded largely for the purpose of helping to combat the terrible infantile mortality rate and instituted as an act of faith by Sir John Atkins, who was appalled by the condition of children brought to his surgical clinic. There have been such projects as the Zymotic Enteritis campaign conducted in 1924/25; outstanding and unique work in the abatement of overcrowding and in connection with the repair of houses under Section 9 of the 1936 Housing Act; original work in connection with houses in multiple occupation; investigations in connection with the hygiene of public houses and their cellars; a Borough food premises survey in 1948 followed by a Clean Food Campaign and Food Hygiene Exhibition in 1950; pioneering work in connection with old people's welfare, and in connection with rodent control and the eradication of bed bugs in the 'bed bug blitz' in 1946. Most recently the Borough has established one of the first General Improvement Areas under the 1969 Housing Act, and the National Society for the Prevention of Cruelty to Children have established their first Battered Baby' investigation centre in North Kensington. The local efforts to ensure a clean atmosphere will be brought to fruition by the completion of the final Smoke Control Areas during the current year. The Borough has had a remarkable influence on such Public Health legislation as The Meat Regulations, 1924; the Preservatives in Food Regulations, 1925; the Food Hygiene Regulations; the 1936 Housing Act (frequently referred to as the Lord Balfour of Burleigh Act); Hostel Byelaws; and the Housing Acts of 1961, 1964 and 1969, particularly in their relation to houses in multiple occupation. Having lost the Maternity and Child Welfare establishments to the London County Council in 1948, the Borough repossessed them in 1965 and have since added three health centres - Walmer Road; Holmefield House, Kensal New Town; and the Violet Melchett Centre. Currently there are in 7 prospect a rebuilding and extension of the Raymede Centre and the establishment of day nurseries in the Lancaster Road (West) Redevelopment, and on the Convent site in Westbourne Park Road. Extensions are being made to the Health Centres in Holland Street and in Lancaster Road. On the welfare side an additional old people's home has been established at Yeading Green, a further one is under construction in Edenham Street, and a third is in prospect in Allen Street. A new adult Training Centre and Day Centre are under construction in St. Mark's Road. I terminate my service with the Royal Borough Council with considerable regret, with many happy memories and with gratitude. I am extremely grateful to present and past members of the Council, and in particular to the Chairmen of Committees with whom I have been concerned. Especially I would mention Alderman Lady Petrie, who was Chairman of the Health Committee for a total of 9 of the years I have been Medical Officer of Health. I am greatly indebted to her for her wise counsel, encouragement and unfailing support for the Department. Her profound knowledge and experience in public health and medical admin istration have been of incalculable benefit to the Borough and to the Department. Her kind and continuing interest in the personal affairs and welfare of the staff has been greatly appreciated. I am also greatly indebted to the friendly co-operation I have always received from the Chief Executive Officer and the Chief Officers and the staffs of other Departments. Lastly and most especially, I pay tribute to all my colleagues in my own Department for their hard work, their willing cooperation and support, their unswerving loyalty, courtesy, cheerfulness and good humour. I have valued their friendship most highly, and I am more than grateful to them for having made the Department such a "happy ship". I wish the Royal Borough and all who live or work in it happiness, prosperity and, above all, good health. I have had the honour to be Your obedient servant, J.H. WEIR Director of Health and Social Services. 8 MEMBERSHIP OF THE HEALTH COMMITTEE (as at 31st December, 1969) The Mayor (Councillor Miss Elizabeth M. Christmas) The Deputy Mayor (Councillor L.A. Kenny) Alderman Lady Petrie " F. Thackway Councillor J. Elliott Brooks (Chairman) " Miss Doreen M. Weatherhead M.S.R., S.R.R. (Vice Chairman) " James R. Ferard " D.H.C. Pritchard " Mrs. Gilbert Russell " Mrs. Brian Sundius-Smith " S.L. Tanner " G.R.G.C. Tickler, M.A. Non Council Dr. J.F.L. King (Inner London Local Medical Committee) Members H.L.A. Burgess MEMBERSHIP OF THE WELFARE COMMITTEE (as at 31st December, 1969) The Mayor (Councillor Miss Elizabeth M. Christmas) The Deputy Mayor (Councillor L.A. Kenny) (Vice Chairman) Alderman Lady Petrie Councillor Mrs. J.A. Albert " Michael Farrow, M.A. " Harvey Gresty " The Hon. Archie Hamilton " J.A.C. Hill " Miss Barbara Hulme, B.A. (Chairman) " Lt. Col. P.W. Le Gros " Miss Shelagh O'Callaghan " Mrs. Prudence Taylor " S. Wilson Non Council Lady Rosula Glyn Members Mrs. Olive M. Wilson, O.B.E. 9 PRINCIPAL AND SENIOR OFFICERS OF THE HEALTH AND WELFARE DEPARTMENT AS AT 3IST DECEMBER, 1969 Medical Officer of Health and Principal School Medical Officer DR. J.H. WEIR Deputy Medical Officer of Health DR. P.J. C. WALKER Principal Medical Officers DR. W.T.D. RAY : DR. H.E.E. GUNN Medical Officers (Whole-time) DR. J. MARTIN : DR. K. G. CASEY DR. F.M. GASKELL : DR. B.D. PERROTT DR. E. SYMMERS Principal Dental Officer MR. M.C. DOWNER Dental Officer (Whole-time) MRS. K.C. McNICHOLL Public Analyst DR. H. AMPHLETT WILLIAMS Chief Welfare Officer MR. S. A. BIDDLECOMBE Deputy Chief Welfare Officer MISS A. BARKER Principal Nursing Officer MRS. J. HARRIS Deputy Principal Nursing Officer MISS L.M. BAKER Assistant Nursing Officers MISS R. ALFORD : MISS M.G. MARES : MRS. M.I. MARTIN Principal Mental Welfare Officer MR. K. CHAMBERS 10 Assistant Principal Mental Welfare Officer mr. p.s. Mcdowell 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) Mrs. m. Smith Senior Home Help Organiser MISS F.I. BARKER Chief Chiropodist MISS H. DUKE Chief Public Health Inspector MR. D.C. DRAPER Deputy Chief Public Health Inspector MR. J.G. TOMPKINS Specialist Housing Inspectors mr. A.F. STANDISH : MR. A.E.F. SILLS Chief Disinfector MR. J.W. NOBLE ADMINISTRATIVE STAFF Chief Administrative Officer MR. G.A. PICKIS Deputy Chief Administrative Officer (Vacant) Principal Administrative Officers MR. C.G. LEGGE : MR. I.M. THOMSON (Finance) (Environmental Health) MR. B.C. DRIVER (Welfare) Section 1 VITAL STATISTICS AND INFECTIOUS DISEASES 11 1969 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 1969 208,480 Average density of population per acre 70.7 RATEABLE VALUE Rateable value of the borough at 1st April, 1969 £26,506,929 Estimated net product of a penny rate 1969/70 £104,300 Estimated number of separately assessed dwellings at 1st April, 1969 60,744 LIVE BIRTHS Males Females Total Legitimate 1,065 1,003 2,068 Illegitimate 264 235 499 1,529 1,238 2,567 Crude birth rate per 1,000 of the estimated population 12.3 Adjusted birth rate for comparative purposes (Area comparability factor=0.60) 7.38 STILLBIRTHS Total (20 males and 12 females) 32 Rate per 1,000 total live and stillbirths 12.3 DEATHS Total (961 males and 1,209 females) 2,170 Crude death rate per 1,000 population 10.4 Adjusted death rate (Area comparability factor=0.97) 10.1 INFANT MORTALITY Infant deaths (all deaths of liveborn children under one year) Males Females Total Legitimate 17 15 32 Illegitimate 10 4 14 Totals 27 19 46 12 Death rate of all infants per 1,000 livebirths 18 Death rate of legitimate infants per 1,000 legitimate livebirths 15 Death rate of illegitimate infants per 1,000 illegitimate livebirths 28 Death rate of male infants per 1,000 male livebirths 20.3 Death rate of female infants per 1,000 female livebirths 15.3 Neonatal deaths (under 4 weeks of age) (19 males and 10 females) 29 Males per 1,000 male livebirths 14.3 Females per 1,000 female livebirths 8.1 All infants per 1,000 livebirths 11.3 Early neonatal deaths (under 1 week of age) (15 males and 9 females) 24 Males per 1,000 male livebirths 11.3 Females per 1,000 female livebirths 7.3 All infants per 1,000 livebirths 9.3 Perinatal mortality (deaths under 1 week plus stillbirths) (35 males and 21 females) 56 Males per 1,000 live and still male births 25.9 Females per 1,000 live and still female births 16.8 All infants per 1,000 live and stillbirths 21.5 MATERNAL DEATHS Maternal deaths nil Maternal mortality rate per 1,000 live and stillbirths nil DEATHS FROM CERTAIN CAUSES Tuberculosis of respiratory system 2 Other forms of tuberculosis 3 Respiratory diseases (other than tuberculosis) (Code Nos. B31, B32, B33(l), B33(2), B46(6)) 296 Cancer (Code Nos. B19(l), (2), (3), (4), (5), (6), (7), (8), (9), (ll)) 438 Heart and circulation diseases (Code Nos. B25, B26, B27, B28, B29) 709 Suicide 43 13 SUMMARY OF VITAL STATISTICS FOR KENSINGTON AND CHELSEA in 1969 (Compared with previous ten years) Year Total Population Total Deaths Crude Death Rate Total Births Crude Birth Rate Total Infant Deaths Infant Mortality Rate 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 1968 210,720 2,234 10.6 2,925 13.9 54 18.46 1969 208,480 2,170 10.4 2,567 12.3 46 18 14 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN 1969 Disease Code No. All Ages Under 1 yr. 1 yr. and under 5 5 yrs. and under 45 45 yrs. and under 65 65 yrs. and over Tuberculosis of Respiratory System B5 2 - - 1 1 — Other Tuberculosis, incl. Late Effects B6 3 • - 2 - 1 Syphilis and its Sequelae B17 1 - - - 1 - Other Infective and Parasitic Diseases Bl8 3 — - 1 — 2 Malignant Neoplasm Buccal Cavity B19(1) 11 — — 3 5 3 Malignant Neoplasm Oesophagus B19(2) 14 — — - 6 8 Malignant Neoplasm Stomach B19(3) 38 — - - 13 25 Malignant Neoplasm Intestine B19(4) 51 — - 3 11 37 Malignant Neoplasm Larynx B19(5) 6 — — — 2 4 Malignant Neoplasm Lung, Bronchus B19(6) 103 — - 2 38 63 Malignant Neoplasm Breast B19(7) 46 — - 7 17 22 Malignant Neoplasm Uterus B19(8) 20 — — - 10 10 Malignant Neoplasm Prostate B19(9) 13 - - - 1 12 Leukaemia B19(10) 13 - - 2 3 8 Other Malignant Neoplasms Bl9(ll) 136 - — 13 43 80 Benign and Unspecified Neoplasms B20 4 - - 1 - 3 Diabetes Mellitus B21 13 - - 2 3 8 Avitaminosis, etc. B22 1 - - - - 1 Other Endocrine etc. Diseases B46(1) 5 — — — 3 2 Anaemias B23 2 - - - - 2 Other Diseases of Blood, etc. B46(2) 1 - 1 - — - Mental Disorders B46(3) 9 - - 6 l 2 Meningitis B24 1 1 - - - - Other Diseases of Nervous System etc. B46(4) 31 — — 3 7 21 Active Rheumatic Fever B25 1 - - 1 - - Carried forward 528 1 1 47 165 314 15 Disease Code No. All Ages Under 1 yr. l yr. and under 5 5 yrs. and under 45 45 yrs. and under 65 65 yrs. and over Brought forward 528 1 1 47 165 314 Chronic Rheumatic Heart Disease B26 51 - - 13 10 28 Hypertensive Disease B27 46 - — 2 11 33 Ischaemic Heart Disease B28 479 - - 10 97 372 Other forms of Heart Disease B29 132 1 - 1 11 119 Cerebrovascular Disease b30 236 - — 5 22 209 Other Diseases of Circulatory System B46(5) 130 1 — 2 10 117 Influenza B31 12 - - 2 3 7 Pneumonia B32 156 9 - 4 10 133 Bronchitis and Emphysema B33(l) 103 - - - 19 84 Asthma B33(2) 6 - - 2 1 3 Other Diseases of Respiratory System B46(6) 19 1 - 2 2 14 Peptic Ulcer B34 10 - - - 2 8 Intestinal Obstruction and Hernia b36 9 - - - 1 8 Cirrhosis of Liver B37 11 - - 1 5 5 Other Diseases of Digestive System B46(7) 17 - - - 3 14 Nephritis and Nephrosis b38 9 — — — 1 8 Hyperplasia of Prostate B39 5 — — — 1 4 Other Diseases; Geni toUrinary System B46(8) 12 - - - 2 10 Diseases of Skin, Subcutaneous Tissue B46(9) 3 - — - 1 2 Diseases of Musculoskeletal System b46(10) 10 - - - 3 7 Congenital Anomalies B42 17 8 4 3 1 1 Birth Injury, Difficult Labour, etc. B43 11 11 - - - - Other causes of Perinatal Mortality B44 12 12 . . . - Symptoms and IllDefined Conditions 1 12 . . - - 12 Motor Vehicle Accidents BE47 26 — - 13 5 8 All Other Accidents BE48 54 2 1 15 17 19 Suicide and Selfinflicted Injuries be49 43 - - 23 17 3 All Other External Causes BE50 11 - — 7 2 2 TOTAL ALL CAUSES 2,170 46 6 152 422 1,544 16 ILLEGITIMACY The proportion of illegitimate births per 1,000 live births is again lower than for several years. The figures are:- 1965 201 1966 201 1967 212 1968 198 1969 194 INFECTIOUS DISEASE The total number of notifications received during 1969 was 466 in comparison with 590 in 1968. Notifications The following Tables show (l) the number of cases of infectious disease notified during the year 1969, 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:- TABLE 1 Notifiable disease Number of cases notified 1969 1968 1967 1966 1965 Diphtheria - - - - - Dysentery 11 14 11 30 31 Encephalitis - 1 - — Enteric Fever 4 1 1 - 5 Erysipelas 1 1 3 4 2 Food Poisoning 53 18 12 20 15 Infective Jaundice 77 4l NOT NOTIFIABLE Malaria 5 2 4 1 1 Measles 211 296 847 515 1,084 Meningococcal Infection 4 1 2 3 4 Ophthalmia Neonatorum 2 - — 2 2 Poliomyelitis: Paralytic - - - - - Non-Paralytic - - — - - Scarlet Fever 7 34 15 18 27 Tuberculosis (all forms) 79 101 77 97 139 Whooping Cough 12 46 78 69 34 TOTALS 466 556 1,050 759 1,344 NOTE: Cases of mistaken diagnosis are excluded from the above Table 17 TABLE 2 Notifiable disease Number of cases notified in 1969 (Age groups in years) Age unknown Under 1 1-2 3-4 5-9 10 - 14 15 - 24 25 and over Diphtheria - - - - - - - - Dysentery - 1 2 3 - - 3 2 Encephalitis - - - - - - - - Enteric Fever - - - - - - 3 1 Erysipelas - - - - - - - 1 Food Poisoning - 3 2 2 2 2 21 21 Infective Jaundice 2 - - 4 7 3 35 26 Malaria - - - - - - 1 4 Measles 2 17 62 45 67 6 9 3 Meningococcal Infection - - - - - 1 2 1 Ophthalmia Neonatorum - 2 - - - - - - Poliomyelitis - - - - - - - - Scarlet Fever - 1 1 2 - 3 - - Tuberculosis (all forms) 2 1 - 3 - 5 20 48 Whooping Cough - - 3 4 5 - - - TOTALS 6 25 70 63 81 20 94 107 18 Disease Total cases notified in each Ward in 1969 TABLE 3 St. Charles Golborne Norland Pembridge Holland Earl's Court Queen's Gate Redcliffe Brompton North Stanley South Stanley Church Cheyne Hans Town Royal Hospital Diphtheria - - - - - - - - - - - - - - - Dysentery - 2 1 2 - 2 - — - 2 2 — — — - Encephalitis - - - - - - - - - - - - - - - Enteric Fever — — — 1 1 1 • - - - - 1 - - - Erysipelas 1 - - - — — — — — — — — — - - Food Poisoning 4 7 4 6 5 6 5 9 1 2 — - 1 2 1 Infective Jaundice 6 8 11 11 5 10 4 6 — 2 10 1 - - 3 Malaria - - — - 1 1 1 1 — - 1 - - - - Measles 57 36 17 14 7 6 8 13 6 11 9 9 8 6 4 Meningococcal Infection - - 1 1 1 1 - - - - - - - - - Ophthalmia Neonatorum 1 - - 1 - - - - - - - - - - - Poliomyelitis - - - - - - - - - - - - - - - Scarlet Fever 2 2 - 2 - - - - - - - 1 - - - Tuberculosis (all forms) 9 11 2 14 7 5 2 11 7 3 4 1 1 - 2 Whooping Cough 2 2 2 3 - - - - - - 2 1 - - - - 19 - Diphtheria For the eighth consecutive year no case of this disease was notified in the borough. Dysentery Eleven cases of dysentery were notified during the year, of which one case was classified as Sh.flexner and one case Sh.boydii, and the remainder Sh.sonne. Generally the cases were of a mild type and there were no deaths. Enteric Fever During the year, four cases of paratyphoid 'B' were notified. Malaria Five cases of malaria were reported during the year and investigations indicated that the illnesses were contracted abroad. Food Poisoning Fifty-three cases of food poisoning were notified. The following table gives an analysis of the cases:- Salmonella enteritidis 5 Salmonella Thompson 3 Salmonella Indiana 2 Salmonella typhimurium 5 Salmonella Montevideo 1 Salmonella Virchow 2 Salmonella Panama 3 Suspected Salmonella 20 Salmonella San Diago 1 Unknown Salmonella 7 Salmonella St. Paul 2 Staphylococcus Aureus 1 Salmonella Stanley 1 Poliomyelitis It is now seven years since a case of this disease was notified in the borough. Ophthalmia Neonatorum Two cases of this disease, the first since 1966, were notified. Both were treated and there was no impairment of sight Smallpox The Ministry of Health's memorandum on vaccination recommends that persons likely to deal with cases of smallpox at short notice should be regularly revaccinated at not more than yearly intervals. During the year 98 members of the staff of the department were vaccinated or revaccinated. Information was received during the year from port authorities of 170 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, 92 were kept under observation for the surveillance period and remained quite well and five were found to have moved to other areas, and the local Medical Officers of Health were notified. The remaining seventy-three persons could not be traced at the addresses given by the port authorities. No case of smallpox has been reported in the area of the present borough since 1929. 20 Tuberculosis During the year, 79 new cases of tuberculosis were notified, of which 65 were respiratory and l4 were non-respiratory. In addition, 24 other cases were reported, mainly by other borough councils of persons moving into this borough. 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 433 231 29 48 741 Every effort has been made by health visitors to visit al1 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 the 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 Africa 2 - - - - - - - - - 2 China 1 - - - - - - - - - 1 Fiji - - - - - - - - 1 - 1 Ireland - - - 1 - - - - - - 1 Malaya - - - - - 1 - - - - 1 Spain - 2 - 1 - - - - - - 3 W. Indies - - - - - 1 - - - - 1 TOTAL 3 2 - 2 - 2 - - 1 - 10 In a further thirteen cases, information concerning origin could not De obtained. 21 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 rtion 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 1968 27 1969 12 This year, thirty per cent (1968 - twenty-eight per cent) of the infected immigrants contracted the disease within one year of arrival in this country; fifty per cent (1968 - thirty-five 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, 10,713 of these certificates were authenticated. In addition, eight special certificates were issued to travellers who refused vaccination on medical or religious grounds. Section 2 PERSONAL HEALTH SERVICES 23 CARE OP MOTHERS AMD YOUNG CHILDREN Maternity and Child Health There were 2,686 notified births in 1969, 242 fewer than in 1960, and of these 2,592 or 96.5% were institutional confinements. Notified births % are drop compared with previous year Crude Birth rate 1965 3737 5.0% 16.91 1966 3454 7 • 5% 15.82 1967 3188 7.7% 14.88 1968 2928 8.29% 13.9 1969 2686 8.2% 12.3 The table above shows the steady fall in notified births and crude birth rate observed in the borough since 1965 and reflected in the falling attendances at ante-natal and child health clinics. 1969 1968 Ante-natal and post-natal clinics: Total number of sessions 495 585 Total attendances 3,280 3,382 Number of women attending during year Ante-natal 799 1,008 Post-natal 21 29 Child welfare clinics: Total number of sessions (infant welfare and toddlers) 1,349 1,359 Total attendances 22,395 25,207 Number of children attending during year Bom in current year 1,826 2,046 Born in preceding five years 3,421 3,403 Total attendances at special toddlers clinics 2,293 2,427 Total attendances at child health sessions (infant welfare and toddlers) have fallen by 2812 from the 1968 figures but against this roust be set the increasing number of children who now attend clinics held in doctor's surgeries. Six of the Council's health visitors are now attached to, or liaise with, five group practices in the borough and it is estimated that at least 3,400 attendances were made during the year at child health sessions held jointly by general practitioners and health visitors. 24 New Premises The Kensal New Town Health Centre was opened in May 1969. This Centre is on the ground floor of a block of flats in a new housing development and caters for families living in the Golborne Ward north of the main Western Region Railway line. Two child health sessions and one Toddlers Clinic are held weekly and attendances are gradually increasing. There are also weekly clubs for Mothers and Old people. Council Day Nurseries It is encouraging to observe the increases in total and average daily attendances which have occurred despite difficulties in maintaining the general staff position throughout the year. Senior nursery staff have undertaken many tasks additional to their normal duties and it has been necessary on occasion to restrict admission of children. The percentage occupation has, except for holiday periods, been consistently over 80% during the year and for one week attained a maximum of 93%. The highest figure during 1968 was 91%. 1969 1968 Approved places 312 312 Total of "weighed registers" 347 347 Total daily attendances 66,843 63,969 Average daily attendance 263 251 Number on waiting list at end of year Priority 1 and 2 38 43 Priority 3 2 14 Occasional Creches The number of weekly occasional creche sessions provided at child health centres and at which children can be cared for while their mothers attend hospitals or clinics or do their shopping, etc., was increased by three during the year to a total of 27. The total number of sessions held during the year was 1,279 and total attendances 17,746, compared with 1,263 and 15,877 respectively in 1968. Nursery Nursing Staff The five day nurseries in the borough have a nursery nursing staff of 61 plus 27 students for whom training for the National Nursery Examining Board Certificate is provided. During the year the fifth nursery, Ladbroke Day Nursery, has been visited by officers of the Department of Health and Social Security and the Department of Education and Science. This has now been approved for training purposes. The first student nursery nurses will be accepted at Easter, 1970. Of six students taking the examination in 1969, five were successful in obtaining their certificates. 25 The general staffing position has been maintained though at times this has been very difficult; the senior staff have undertaken many tasks additional to their normal duties and on occasion the staffing position has been so low that it has been necessary to restrict the admission of children to the nurseries. Private Day Nurseries. Child-Minders and Playgroups In my report for 1968 reference was made to the provisions of Section 60 of the Health Services and Public Health Act, 1968, which amended certain provisions of the Nurseries and ChildMinders Regulation Act, 1948, and came into effect on the 1st November, 1968. These amendments brought within the scope of the principal Act premises open for a daily aggregate period of two hours or more and child-minders receiving one or more children. Previously the criteria had been three hours (a matter of practice not legally prescribed) and more than two children respectively. Increases in the numbers registered in both classes is shown in the following table:- Registered Day Nurseries and Child-Minders 1969 1968 Number of registered day nurseries at 31st December 41 24 Number of places 1,005 710 Number of child-minders registered at 31st December 72 20 Number of children authorised 182 91 A feature of the new registrations is that both premises and child-minders individually take fewer children. This was to be expected as the legislative amendments directly affected childminders receiving fewer children and small playgroups of which the active sessions were previously regarded as too short for registration. New registrations resulting were in respect of sixteen premises receiving 260 children and 46 child-minders receiving 78 children. Ten premises are organised on sessional lines and although their total number of places is only 172, in effect they provide sessional care for a much larger number of children. Following receipt of the Department of Health and Social Security Circular 37/68, the Council approved a scheme to pay for the private day care of children in the priority groups by selected child-minders or in private day nurseries. The Council pays the child-minders at the rate of 15s Od per day and private day nursery charges at rates considered reasonable on individual consideration. In both cases parents are assessed to pay contributions towards the charges to the Council as if the children were accommodated in a Council day nursery. At the end of the year, there were two children placed under this scheme one with a child-minder, one in a nursery. 26 The 62 new registrations resulted from a total of 121 individual enquiries. Eleven registered minders either decided to give up minding or moved out of the borough. Thus it will be seen that the volume of work involved was much greater than the additional registrations would indicate. This necessitated the appointment of an additional assistant nursing officer to undertake the supervision of this work in the field and a clerical officer to assist in the administrative procedure. Regular supervision is maintained and the standard of private care has remained consistently satisfactory. 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 the. 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 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. 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 1969:- 1969 1968 1967 1966 Adoption Cases Children suitable for adoption 16 17 29 22 Children suitable for adoption subject to certain conditions - - - 1 Children unsuitable for adoption 1 1 1 - Couples suitable to adopt children 13 17 21 12 Couples unsuitable to adopt children - 1 — - Boarding Out Cases Children suitable for boarding out 24 21 20 15 27 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 972, compared with 943 for 1968. The following is a summary of handicapped children who were on the register at the end of the year:- Handicapping Defects Number of Children 1969 1968 Defects of vision 11 8 Defects of hearing 7 3 Cerebral Palsy, orthopaedic defects and defects of the central nervous system 55 34 Cardiac defects 37 24 Epilepsy 5 3 Mental retardation 19 13 Other handicaps 35 26 Multiple handicaps 34 36 TOTAL 203 147 Notification of Congenital Malformations (Corresponding figures for 1968 are shown in brackets) During the year, 59 (41) 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 8 (2) stillbirths, 8 (7) children showing more than one defect, and 5 (2) with multiple abnormalities and gross defects. The following is a summary of defects as classified by the Registrar-General:- Defects Total number 1969 1963 1967 Central nervous system 15 7 8 Eye and ear 1 nil 1 Alimentary system 4 4 4 Heart and great vessels 1 1 4 Respiratory system nil nil nil Urogenital system 5 6 5 Limbs 27 21 30 Other skeletal defects 7 3 2 Other systems and malformations 5 3 7 Multiple malformations 5 2 2 28 Cervical Cytology Since it was first demonstrated by Papanicolaou and Traut of the United States in the 1940's that the examination of cells in vaginal secretions could reveal unsuspected pre-cancerous conditions of the uterine cervix, it has gradually come to be accepted that such an examination should be available as a screening process for all women in the age groups "at risk". When "cervical screening" had been accepted in principle by the Minister of Health who envisaged a service provided by general practitioners and local authorities for women over 35, centres were established for training laboratory technicians and Hospital Boards were asked to consider the provision of laboratory services. Prior to April, 1965, cervical screening in the London County Council area was restricted to small experimental schemes and in this area cervical smears were being taken only in hospital gynaecological departments and clinics of the Fmaily Planning Association. Shortly after this Council became responsible for the personal health services, a cytological centre was established by the South Western Metropolitan Regional Hospital Board at St. Stephen's Hospital and the Consultant Cytologist intimated that he could accept a limited number of cervical smears from Kensington and Chelsea Clinics in the area served by the Board, i.e. that part of the borough south of Holland Park Avenue. Negotiations between the hospital and the Council's officers followed and the Council decided that clinics would be opened at two centres. Ministerial approval for the scheme was given in November 1965. 1966 Early in February 1966, cytology sessions began at South Kensington and Holland Street Centres at fortnightly intervals. As the laboratory could accept only 50 smears a month, the service was restricted to women over 30 and, in order to regulate the demand in the early stages, was offered only by health visitors and general practitioners to women already known to them who were considered to be in the high risk groups. The opening of cytology clinics in the southern part of the borough was followed by a demand for a similar service in the North Kensington area and as soon as laboratory facilities were made available, a screening clinic was opened at the St. Quintin Centre on 29th June. The clinic was held monthly at first, but in December the laboratory at the then Paddington General Hospital agreed to accept double the number of smears and clinics were then held every fortnight to cater for 20 women a month. Towards the end of 1966, the Royal Marsden Hospital, which was already providing a screening service in "Well Woman" Clinics, suggested that the Council should accept some financial responsibility for borough residents. This was agreed by the Council and implemented early in 1967. To sum up for 1966, cervical cytology was made available throughout the borough on a limited scale; 54 sessions were held and 433 women attended. 29 1967 As the average attendance during 1966 was only 8 at sessions designed to accommodate 10 to 12, it was felt that the service could be more widely advertised and, in March, a letter from the Chairman of the Health Committee appeared in the local press urging eligible women to avail themselves of the facilities provided. Other articles appeared in both the local and national newspapers and there was considerable activity by women's organisations and by the National Cervical Cancer Prevention Campaign. In spite of this, Clinic attendances remained low and throughout the year, 390 women were seen at 68 sessions, an average of only 6 per session, a disappointing figure in view of the considerable nationwide publicity and the insistence of pressure groups and other organisations that there was a great demand for the service. Towards the end of 1967, the Consultant Cytologist at St. Stephen's Hospital intimated that the laboratory could accept an increased number of smears from this borough and the Council decided that plans should be made for an intensive publicity campaign to reach all women resident and employed in the Borough. The campaign was timed to start early in the following year, when it could be expected to arouse more interest than during the Christmas and "Sales" periods. 1968 Publicity began in mid January. A simple leaflet giving details of the test and services available was distributed to Welfare Centres, Day Nurseries, Community Centres and women's organisations. The same information was also included in "Local Affairs" sent to all rate-payers and tenants of the Council and in this instance, to tenants of other blocks of flats who would not normally receive it. Approaches were made to the large stores and to industrial and commercial organisations inviting them to send their women employees to the Council's Centres, or alternatively offering to send the Council's staff to run clinics on their premises if suitable facilities were available. The making of appointments was simplified and arrangements were made to double the number of sessions held at very short notice if necessary and to provide an evening session on "late shopping night" if there were any demand for it. Several commercial organisations responded by sending lists of staff with a request for appointments and, in August, 3 sessions were arranged in the medical department of a large store where 60 women were seen. This intensified publicity resulted in 779 attendances throughout the year as compared with 390 in 1967 and 15 extra sessions were held including several in the evenings. Results on the whole, however, were disappointing in view of the fact that almost every woman in the borough must have been reached by propaganda in some form. 30 1969 Throughout 1969, cytology sessions have continued in the Council's centres at the rate of 6 a month with attendances averaging 6 per session. In February, a large store with many women employees asked if cytology clinics could be held in the staff clinic and it was arranged that two sessions would be held every week for as long as necessary. In all, 23 sessions were held and 307 women examined. By the end of 1969, cytology sessions had been running for four years and so far all women have been "first attenders". It is, therefore, interesting to take stock of results and observations made. Year Sessions held Possible attendances Actual attendances Positive smears 1966 54 580 433 6 1967 68 700 390 2 1968 87 1044 779 5 1969 95 1140 773 2 TOTALS 3464 2375 15 Demand for the Service The purpose of cytological screening is to eradicate cancer of the uterine cervix as a cause of death by detecting the condition in the pre-malignant state when it can be successfully treated. Ideally, all women in the vulnerable age group and more especially those in the high risk groups of high parity and lower social class should be screened every five years. In this borough, therefore, with approximately 40,000 women "at risk", 8,000 should present themselves annually for examination but in practice, the total numbers seen during 1969 at the Council's clinics and the Royal Marsden Hospital were 773 and 326, a total of only 1,099 and of these many were under 35 and not in the "at risk" group. Attendance by Social Class The incidence of precancerous conditions of the cervix is known to be three times greater in the Registrar General's Social Classes 3, 4 and 5 than in Classes 1 and 2, but unfortunately experience throughout this country has been that women of the lower social groups are least likely to come forward for examination. This is borne out by investigation of records of over 1,000 women seen at the Council's Centres - it was found that 33 Per cent were from Social Classes 1 and 2 compared to 24 per cent in the borough population as a whole. 31 Detection Rate A "positive" smear is one showing cells which the cytologist considers to be premalignant. During the four years - 1966 to 1969 - there have been 15 positive smears reported out of 2,375 - a rate of 6.3 per 1,000 which is very close to positive rates of 6.1, 6.7 and 6.9 per 1,000, reported from similar surveys in Edinburgh, Aberdeen and Oxford. Follow-up of patients The population turnover in Central London is high and even with the rapid reporting of a positive result, there has been some difficulty in tracing the woman concerned. There are many other cases, however, where minor gynaecological conditions are found and women are referred to their own doctors for treatment and asked to attend for further testing in 3, 6 or 12 months. Three appointments are sent to each woman - often without result - and in many cases, it has proved impossible to make any further contact with her. Screening of "Non Volunteers" Although the figure of voluntary attenders is low, a much larger number of women, mostly those of childbearing age, are having smears taken when they attend hospital obstetrical and gynaecological departments and family planning clinics. At the four hospitals where the great majority of Kensington and Chelsea women are confined, smears are taken as a routine at ante-natal or post-natal clinics and during 1969, 1,600 women are known to have been examined. At least another 1,000 were examined at clinics of the Family Planning Association and an unknown number at hospital gynaecological departments and other maternity hospitals. It is very likely, therefore, that the total number of women screened during 1969 may well have been as high as 4,000 but 75 to 80 per cent of these were under 35 and therefore not in the "at risk" population. In conclusion:- 1. In spite of considerable national and local propaganda, as with cigarette smoking, the risk of cancer does not provoke much preventive action and there is no great demand for the screening service. 2. The service provided by the Council at present is more than adequate to meet the demand. Over the four years reviewed there have been only 2,375 attendances out of a possible total of 3,454. 3. Many women who do not elect to attend cytology clinics are being screened in the course of other medical examinations and investigations but the great majority of these are under 35 and are not in the "at risk" group. 4. There is a hard core of women over 35 who are "at risk" and who do not seem to be reached or influenced by publicity and propaganda and it is to these that future effort will have to be directed if the screening programme is to be effective and deaths from cervical cancer prevented. FAMILY PLANNING Family planning services within the borough continued to be provided by the West London Branch of the Family Planning Association. Regular sessions are held each week at five premises in the borough, two of these being Council Health Centres,which are used by the Association free of charge. 32 The Council decided in July, 1968, to implement in full the provisions of the National Health Service (Family Planning) Act, 1967, and the service is available to all borough residents, whether married or unmarried, over the age of 16 years. The Council accept financial responsibility for advice, treatment and appliances supplied except in those cases where there has been no recommendation on medical or medico-social grounds, when the woman is expected to pay for her own pills and appliances. Where the recipient is deemed to be in necessitous circumstances, i.e. is receiving, or eligible to receive, supplementary benefit, the Council undertake payment in full. During 1969, the Council met the cost of family planning help for 3.197 residents. The total number of patients (including non-borough residents) dealt with at the Family Planning Association's clinics in Kensington and Chelsea during the year is summarised as follows:- Number of new patients during year Total number of patients (old and new) Total clinic sessions Total doctor's sessions North Kensington Marriage Welfare Centre, Telford Road 2,129 12,330 570 979 Kensington Clinic 9 Holland Street 267 1,215 50 79 Chelsea Clinic Violet Melchett Health Centre 193 890 52 52 Chelsea Clinic St. Stephens Hospital 760 4,346 112 262 St. Charles Hospital 138 391 34 34 TOTALS 3,487 19,172 818 1,406 Family Planning at St. Mary's (Harrow Road) Hospital In June, 1968, the Council agreed that women delivered in this hospital should be included in arrangements made by Westminster City Council and the hospital authorities to introduce family planning to patients while still in hospital. 33 A health visitor of the Westminster City Council visits patients in the maternity wards and family planning is discussed with them; if contraceptive advice is requested, an appointment is given at an adjoining Westminster City Council clinic. Follow-up and further treatment is arranged at a Family Planning Association clinic within the borough. The great advantage of the arrangement is that family planning can be discussed when the patient is free from domestic and other duties, and more likely to benefit from the advice given. Care of the Unmarried Mother and her Child The Council continued to grant aid to the London Diocesan Council for Moral Welfare and the Crusade of Rescue (Westminster Catholic Moral Welfare Association) in 1969. Marriage Guidance Grants were again made by the Council to the undermentioned organisations in respect of their work with residents of the borough during the year:- London Marriage Guidance Council £700 Catholic Marriage Guidance Council £375 Facilities continued to be provided free of charge at the Lancaster Road Health Centre and at the South Kensington Health Centre for a weekly session at each for the London Marriage Guidance Council. DOMICILIARY MIDWIFERY During the year the appointment had been made of a non-medical supervisor of midwives. This has had the effect of drawing the borough's midwives closer into the community nursing team and so enabling them to play a fuller part in health education and student programmes. The domiciliary services are undertaken by the midwives of the Council, except for a district in the north of the borough where the service is provided by midwives of Queen Charlotte's Hospital. Midwifery previously undertaken by the Kensington District Nursing Association was transferred to the Council's staff. The demand for domiciliary confinement continues to fall. Year No, of Home Confinements Percentage Reduction 1965 310 1966 236 24 1967 139 41 1968 102 27 1969 73 28 34 In addition to these domiciliary cases, the midwives have attended planned and unplanned discharges whose numbers have increased from 184 to 204 during 1969. They have also attended 40 mothers in the General Practitioner Unit at St. Mary Abbots Hospital. These are mothers who are medically and obstetrically normal, but, who, for varying reasons, cannot conveniently be delivered in their homes. Cases booked with a doctor Cases not booked with a doctor 1969 1968 1969 1968 Council's midwives 57 81 25 Hospital midwives 13 8 18 TOTAL 70 89 3 13 Planned early Unplanned early discharges discharges 1969 1968 1969 1968 Nursed by Council's midwives 108 30 57 31 Nursed by Kensington District Nursing Association 22 78 4 36 Nursed by hospital midwives 10 6 3 3 TOTAL 140 114 64 70 1969 1968 1969 1968 Number of confinements in General Practitioner Maternity Unit 40 35 Doctor present 38 31 35 Training of Pupil Midwives Eight pupil raidwives completed their training during the year, two remained in training at the end of December. Each pupil has delivered at least six mothers in their own homes and in addition have attended cases in the St. Mary Abbot's General Practitioner Unit and mothers and babies discharged from hospital ^8 hours after delivery. The pupils have learned about the care and services available in the community, by informal teaching, and a varied programme of visits to other departments of the Council and to outside bodies. They have attended health centres for visits of observation to cytology clinics, family planning clinics and psychoprophylaxis classes and have been encouraged to take part in parent craft teaching. As a result it is hoped the pupils have been given a wider outlook. Experience gained from this adaptation of their training programme, and also from two experimental schemes undertaken outside London, is helping towards the planning of a new one-year training for midwives, whose experimental syllabus has just been approved by the Central Midwives Board. Hidwives 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:- 1969 1968 Notifications received from midwives of intention to practice 107 100 Refresher courses attended by midwives in accordance with Section 9 of the rules of the Central Midwives Board 10 8 Fees paid to medical practitioners called in by midwives in emergency nil nil health visiting The duties of the health visitor have widened over the years from concentration upon the mother and her young child to the whole family and its place in society. This includes the adolescent, the handicapped and the elderly and a wide range of health education activities, both in her day to day work, in clinics and daily visits to homes, and in informal situations in mothers' clubs, mothercraft classes, schools, youth groups, teacher training courses, old people's clubs and to many varying voluntary organisations. 36 In order to assess the proportion of time used in each of these varying activities and to show their diversity, a very full and comprehensive survey of the work of the health visitor was undertaken during September and October throughout the London area. This research on behalf of the London Boroughs' Training Council was undertaken by the Greater London Council's Research and Intelligence Unit. After very careful briefing meetings, eight health visitors in this borough undertook for two weeks to list and itemise every activity of their working day. The report of these findings to be published early in 1970 should be of value in the future use and planning of the health visitor service. The challenge of varied experience provided in this borough continues to attract health visitors of a high calibre and the staffing position has been maintained. Six students were sponsored for health visitor training and upon successfully gaining their final certificates took up permanent positions on the staff. Training facilities were again given for ten health visitor students from the Royal College of Nursing, The North Western Polytechnic, Chiswick Polytechnic and the University of Surrey, to gain practical experience with a fieldwork instructor. The attachment of health visitors to general practitioners has continued, and in some practices the domiciliary midwife and district nurse complete the team. Development of these attachments is necessarily slow as few doctors are as yet working in group practices. At present, three health visitors are working full-time in three group practices with eleven general practitioners; while three are working part-time in a further three practices with five general practitioners. This method of working provides added interest and variety for all members of the practice and although the actual number of home visits may be reduced, their value is enhanced. Health visitors continue to teach in the schools of nursing at St. Charles and St. Stephen's Hospitals on the community aspects of health and disease and the preventive and social care available outside the hospital. 37 The following table records details of visits by Health Visitors: 1969 1968 First visits to:- Children born 1969 2,333 2,481 Children born 1968 2,122 2,161 Children born 1964/67 4,149 4,348 Persons aged 6$ or over 299 275 Mentally disordered persons 57 56 Persons discharged from hospital (excluding mental) 83 49 Tuberculous households 124 157 Infectious households 6 14 All other cases 1,449 1,534 Total cases visited 10,621 11,077 Total effective visits and revisits 29,816 32,087 Unsuccessful visits 9,697 10,571 In-Service Training A number of talks were arranged for the nursing staff. These included a talk by Dr. Faith Spicer on "Health Education in Personal Relationships", Professor Henry Kempe of Denver Colorado and Miss Joan Court of the N.S.P.C.C. on "The Battered Child Project". Dr. D. C. Newman, Consultant Pathologist, St. Marys Hospital for Children, spoke and demonstrated the Guthrie Test for phenylketonuria and Mr. T. S. Campbell, Educational Psychologist at the Earls Court Child Guidance Unit.spoke on "Some difficulties with school children". Nursing officers acted as lecturers on courses arranged by the London Boroughs' Training Committee, including the introductory course for school nurses and the refresher course for day nursery matrons. One nursing officer took part in a seminar at the Hospital Centre where participants were nurses working in alcoholic units in the United Kingdom. A nursing officer acted as group leader at a conference of nursing officers of the London Boroughs and Tutors of training schools within the London area, which was organised by the Council for the training of Health Visitors. A nursing officer took part in a discussion in preparation for a television documentary programme depicting the statutory and voluntary social services available to families. Students and Visitors Visitors from overseas, including 3 visitors from the U.S.A., 2 from Australia, 1 from Canada and 1 from Finland, spent some time with the nursing officers, learning of the work of the department and made visits of observation to health centres and day nurseries. A new scheme was started for three pupils from Ladbroke Upper School to v/ork voluntarily for one half day a week during the school term at three separate day nurseries. 38 Visits of observation from ½ - 5 days to day nurseries and health centres were made by the following group:- 126 student nurses from St. Stephens and St. Charles Hospitals, 12 students from North Western Polytechnic, taking the course in residential child care, 40 student teachers from the Froebel Institute, 10 student dieticians from Queen Elizabeth College, 17 pupil midwives, 14 nursery students, 5 student health visitors, 7 students from Royal College of Nursing, taking a one year course in teaching methods, 30 pupils from local schools, 5 state enrolled nurses from Queens Institute of District Nursing, 2 students from King's Fund College of Hospital Management, 6 social work students from North Western and Chiswick Polytechnics, 6 staff nursery nurses from North Western Polytechnic, taking the refresher course for qualified experienced nursery staff and a Home Economics student from Isleworth Polytechnic. HOME NURSING This service is provided by the Kensington District Nursing Association for the whole of the borough area, and the Council reimburse the Association to the extent of 93% of net approved expenditure incurred in providing the service. The supervising staff consisted of the superintendent (Miss E. M. Evans, SRN, SCM, MTD) and two assistant superintendents. Other home nursing staff employed at 31st December, 1969, were as follows:- State registered and state enrolled nurses 37 Total full-time equivalent 35.6 Students 4 The figures of patients nursed for the year, compared with the previous year, are as follows 1969 1968 Number of patients attended 2,643 2,768 Total visits paid 90,020 89,170 Average number of visits to a patient 34 32.1 Number of patients attended for at least three months 225 196 (or 8.5%) (or 7.1%) 39 Further details of cases, visits and treatments appear in the following tables:- Types of case Number of new cases under' taken Percentage of total 1969 1968 1969 1968 Medical 1,585 1,675 84.6 80.0 Surgical 239 257 12.6 12.3 Tuberculosis 11 19 0.6 0.9 Maternity - early discharge from hospital 26 117 1.4 5-6 Maternity - complications 2 15 0.1 0.7 Mental ill-health 13 10 0.7 0.5 TOTAL 1,876 2,093 100.0 100.0 Visits for At patients' homes Elswhere Total Percentage of total 1968 1969 1968 1969 1968 1969 1968 1969 Injections only 20,267 18,947 733 966 21,000 19,913 23.5 22.1 Injections plus other treatment 2,130 2,805 8 52 2,138 2,857 2.4 3.1 Other treatment only 66,023 67,210 9 40 66,032 67,250 74.1 74.8 T0TAL 88,420 88,962 750 1,058 89,170 90,020 100.0 100.0 Age distribution of patients Number of patients Percentage 1969 1968 1969 1968 0-4years 37 45 1.4 1.6 5-64 years 834 1,108 31.5 40.1 65 years and over 1,772 1,615 67.1 58.3 TOTAL 2,643 2,768 100.0 100.0 Nursing Treatments 1969 1968 Total number of completed treatments 2,085 2,174 Total number of patients being nursed at end of year 703 763 40 It is noteworthy that while the number of patients and completed treatments are less than in 1968, the numbers and proportions of elderly patients have increased together with the average number of visits per patient and the numbers of patients attended for at least three months. In addition to being a medical member of the London Boroughs Training Committee Advisory Body of Chief Officers, I am Chairman of the Committee's District Nurse Working Party. I am also a member of the Department of Health and Social Security Panel of Assessors for the training of District Nurses. 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. Loan of home nursing equipment Under Section 28 of the National Health Service Act, 1946, the Council provide 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 this service. A supplementary service is provided by the British Red Cross Society. During the year, the Council gave this Society a grant of £12$ towards this work. The demand for all types of equipment has increased as indicated by the 388 issues made by the Council, and 706 by the British Red Cross Society, as compared with 257 and 720 respectively during 1968. The demand for incontinence pads has remained steady, 219 patients having been served compared with 221 in 1968. Adaptation of homes to install artificial kidney machines One application was received during 1969 for works of adaptation to the home of a patient accepted for chronic intermittent haemodialysis to be performed in her own home. The property in Notting Hill in which the works of adaptation were required were partly occupied by the patient - a single woman aged 25 years - together with three other young friends. Together they lived in a garden flat of which she was the lessee, occupied on a lease expiring in 1972. The landlords were themselves lessees of the property with limited power to make alterations to the premises and it was necessary for the patient to complete a licence in respect of the works and installation and including an Undertaking to reinstate the flat. It was again found that the cost of works of adaptation exceeded the amount anticipated by hospital authorities and in this instance was plus certain fees and ultimate reinstatement costs. 41 Representations have been made to the Department of Health and Social Security with a view to the burden of cost of adaptations being accepted as a charge against the National Health Service. The Department's view was that although renal patients need the backing of hospital departments, because they are able to live and work in the community, it appeared right that provision of this kind should be made through the services of the local health authority. HOME HELP SERVICE The demand for this service continued to be heavy although lower than in 1968; the number of households assisted showing a fall of about 7% and new applications about 175. It was still greater than could be met in full by the staff available although every eligible applicant was given service. The heaviest demand continued to be from old people and comprised 81$ of all households assisted compared with 80$ in 1968. Details of the home help work carried out are as follows:- 1969 1968 Number of households assisted 1,607 1,719 Number of new applications received 633 758 Details of households assisted:- Maternity 25 37 Tuberculosis 8 12 Old People 1,304 1,371 Chronic sick 124 149 Early morning and evening help 9 12 Special help (problem families) 2 nil Mental disorders 7 6 Miscellaneous 128 132 Staff details:- Number of home helps employed at end of year 126 139 Equivalent of whole-time staff 112.91 123.85 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. Three such cases occurred during 1969, whereas there were none in 1968. 42 IMMUNISATION AND VACCINATION The programme of vaccination of susceptible children against measles which was introduced in May, 1968, has continued as a routine offering to children as they attain the age of 14 months. The 1968 programme included a back-log of older children and of the total number vaccinated in that year, nearly 50% were of school age. During 1969, children born in 1967 to 1968 comprised 80% of the total vaccinated. Details of the numbers vaccinated are as follows:- 1969 1968 At Council clinics 854 2,993 By general practitioners 243 214 TOTAL 1,097 3,207 The decline noted in 1968 in the number of cases of measles notified has been confirmed by the figures for 1969. a year which could have been expected to show the hitherto normal biennial epidemic. The annual totals of notifications from 1963 onwards are given below:- 1963 1964 1965 1966 1967 1968 1969 1,296 428 1,084 515 847 296 211 Vaccination and Immunisation against other diseases In my report for 1968, I drew attention to the effect of the modified immunisation programme whereby fewer completed courses were recorded during the year. This is still valid for 1969 and it will be seen that the figures for completed primary courses of vaccination against poliomyelitis, diphtheria, whooping cough and tetanus are at about the 1968 level in respect of children attending the Council's clinics, but there is a decline in the numbers attending their own general medical practitioners. The reductions in reinforcing doses for diphtheria, whooping cough and tetanus immunisations arise from the omission in the modified schedule of two booster doses, triple antigen previously given to 15 months old children and diphtheria/ tetanus at 8 to 9 years old. The acceptance ratio for all the foregoing and smallpox vaccination is still at an unsatisfactorily low level. 43 The returns of the numbers of immunisations carried out at Council clinics and by General Practitioners during the year are as follows Poliomyelitis Immunisation Total primary courses completed Total reinforcing doses 1969 1968 1969 1968 At Council clinics - Salk 1 3 nil nil Sabin 1,634 1,656 1,626 1,589 By general practitioners - Salk nil nil nil nil Sabin 336 441 237 176 total 1,971 2,100 1,863 1,765 Diphtheria Immunisation Total primary courses completed Total reinforcing doses 1969 1968 1969 1968 At Council clinics By general practitioners TOTAL 1,344 284 1,325 417 2,274 407 3,089 506 1,628 1,742 2,681 3*595 Whooping Cough Immunisation At Council clinics Total primary courses completed Total reinforcing doses 1967 1968 1969 1968 1,018 971 765 1,147 By general practitioners TOTAL 254 376 222 319 1,272 l,347 987 1,466 44 Tetanus Immunisation Total primary courses completed Total reinforcing doses 1969 1968 1969 1968 At Council clinics By general practitioners 1,345 293 1,362 423 2,280 425 3,053 527 TOTAL 1,638 1,785 2,705 3,580 Smallpox Vaccination At Council By general Total clinics practitioners 1969 1968 1969 1968 1969 1968 Primary vaccinations Under 1 year 16 32 18 33 34 65 1 year 661 828 162 195 823 1,023 2-4year 272 240 83 80 355 320 5 - 14year 30 34 36 37 66 71 15 years and over 8 3 7 1 15 4 TOTAL 98? 1,137 306 346 1,293 1,483 Revaccinations Under 1 year nil nil 1 nil 1 nil 1 year nil 4 nil nil nil 4 2-4year 15 11 20 14 35 25 5 - 14 years 22 25 113 115 135 140 15 years and over 9 7 21 10 30 17 TOTAL 46 47 155 139 201 186 Tuberculosis (BCG Vaccination) Thirteen-year old schoolchildren The acceptance rate for this protective measure is still at a satisfactorily high level. The skin test used is Mantoux (10 TU). 1969 1968 Schools visited 4 8 Number of eligible children 710 1,018 Number of acceptances 520 958 Acceptance rate 73.2% 94% Number skin-tested and read 382 694 Number given BCG vaccination 343 630 Number of positive reactors 39 64 Positivity rate 10.2% 9.3% 45 Contacts The numbers of contacts of cases of tuberculosis dealt with at chest clinics has fallen nearly 12% from the 1968 level. The positivity rate in this group has risen to 37.5% as compared to 28.5% in 1968. 1269 1968 Number skin-tested and read 130 147 Number found negative 81 105 Number given BCG vaccination 79 108 Number found positive 49 42 MASS RADIOGRAPHY As in previous years, the South West and North West London Mass X-ray services continued to provide chest X-ray facilities for the borough at their centres in the Western Hospital, Seagrave Road, S.W.6., and 285 Harrow Road, W.9. In addition to the operation of these two centres, mobile units made numerous visits to large establishments within the borough. PREVENTION OF ILLNESS. CARE AND AFTER-CARE Chiropody Staffing difficulties have continued and despite all efforts to improve the situation, the chief chiropodist has remained the only fulltime member of staff in this service. A number of sessional chiropodists have been employed to fill the remaining four full-time posts on the establishment and as the majority of them have been able to continue regularly, the overall situation, while not entirely satisfactory, has been more stable than in previous years. It is, in any event, convenient to employ some sessional staff as the demand from the areas served by each of the smaller clinics, at Westbourne Grove, Earls Court Road and Walmer Road, does not justify any one of them being there on a full time basis. There was, however, a slight increase in demand in the Walmer Road area, and here it was possible to provide clerical assistance for the chiropodists, an arrangement which enabled their sessional loading to be increased, effecting an equivalent of nearly two additional weekly sessions without any increase of chiropody staff, A number of factors have hindered progress with the proposed new clinic at the Violet Melchett Centre, Flood Walk, S.W.3o. but the indications are that it will open early in 1970. The arrangements begun in 1968 to provide a service for former patients of the Chelsea School of Chiropody were continued. The chiropodist in private practice carried out an average of 14 to 15 treatments weekly and from the beginning of May transport for 10 or 12 selected patients to the new premises of the School in 18 Saraford Street, N.W.8., was provided weekly instead of fortnightly. 46 Details of attendance, etc., are as follows:- 1969 1968 Total number of sessions held at Council clinics 1,527 2,007 Number of persons attending Council clinics 2,307 (no comparable figure) Analysis by age-groups of attendances at Council clinics Children - Under 5 nil 1 5 to 14 years 92 322 Males - 15 to 64 years 995 1,228 65 years and over 1,308 1,260 Females - 15 to 59 years 3,037 4,043 60 years and over 6,256 6,546 Total attendance at Council clinics 11,688 13,400 Number of attendances at Chelsea School of Chiropody made by patients for whom the Council provided transport between home and clinic 243 25 Number of patients referred to private chiropodist 59 85* Number of treatments given by private chiropodist 747 189* * Service commenced 19th August, 1968 RECUPERATIVE HOLIDAYS The decline in the number of recuperative holidays for persons classified as "other adults" who are mainly elderly persons noted in my Report for 1968, has continued. The demand for holidays for children, and particularly for school children, shows a pattern, which is not dissimilar to that of the biennial measles epidemics which occurred in 1965 and 1967, but, as reported elsewhere, did not materialise in 1969. The sympathy between these figures may, however, only be coincidental. Recuperative holidays - 1969 1968 1967 1966 1965 Children under 5 22 11 17 11 22 School children 37 54 76 44 55 TOTAL 59 65 93 55 77 Measles notifications 211 296 847 575 1,084 - 47 - Admissions to holiday homes were as follows:- 1969 1968 Expectant and nursing mothers 11 6 Other adults 74 81 Children under five years of age 22 11 Schoolchildren 37 54 Health Education The need for Health Education continued during 1969 is a continuing process carried on by fieldworkers, much of it so far as mothers and young children are concerned by health visitors, on a day-to-day and person-to-person basis as part of their ordinary -duties. Public health inspectors and other members of the staff also play an important part. The Council's links with national organisations active in this field were maintained during the year and Dr. W. T. Densham Ray, Principal Medical Officer for the School Health Service, continued his membership of the Inner London Education Authority's Panel on health education. As in previous years, a phased programme was devised at the beginning of the year to enable special attention to be given to a number of key subjects. The programme for the year was:- March and April Danger from Poisons in the home May and June Dental Health education July and August Preparing for school; play, including road safety September and October Day-care of children November and December Home Safety and prevention of accidents in the home 48 Dental health education The following activities took place during the year:- (a) In May and June this subject was featured as a special topic for health visitors and school nurses. (b) The Dental Health Education Officer of the Inner London Education Authority gave talks in eleven primary schools in the borough during November. (c) Dental hygiene packs consisting of toothbrush, toothpaste, rinsing mug and a letter to parents on dental health education were distributed to as many new entrants to primary schools as supplies would allow, at the time of their first routine dental inspection. (d) Packages of dental health education material were distributed to interested head teachers to assist teachers in organising class projects on this subject. (e) The principal dental officer wrote camera scripts for, and took part in two video-taped trial productions on dental health education for the I.L.E.A. Educational Television Service. These were in the form of short flashes for insertion between other programmes. After the trial productions have been evaluated by finding out the reactions of teachers, educational psychologists and groups of children to them, it is hoped to produce some video-tapes for closed circuit broadcast to schools. In addition, the Inner London Education Authority decided to purchase equipment and material for a Mobile Dental Health Education Unit to tour schools in the borough. By these and other means, it is hoped to stimulate active participation by pupils in class projects on dental health education and this is probably the most effective means of motivating a positive acceptance of oral hygiene. Stress is also laid on the importance of health education at the chair side to encourage improvement in oral hygiene and dietary practices and the Council's dental officers accordingly emphasize preventive aspects as part of clinical treatment. Health education in schools Arrangements already in operation continued during 1969. The following is a summary of activities undertaken. Ladbroke School (Senior Girls): Regular weekly talks to fourth year pupils by two Health Visitors. Similar weekly talk by one Health Visitor to fifth and sixth year pupils. St. Thomas More H.C.: Weekly talk by Health Visitor to two groups with approximately 14 girls in each group. St. Francis R.C. (Junior Girls): Weekly talks by two Health Visitors to two groups of approximately twenty children aged 10 to 11 years. Holland Park School (Senior Girls): Series of five talks to each of two groups of 15 fourth year girls. This course has been taught by two health visitors. 49 Talks in schools covered a wide range of subjects suited to the age of the pupils and as requested by Head Teachers, included social relationships, marriage, procreation, care of baby, physical and emotional development, dental care, home safety, cancer education, venereal diseases, nutrition, parent/child relationship, care of the elderly and handicapped, smoking and other related topics. Use is made, where appropriate, of such visual aids as slides, films, etc. Home safety campaign This campaign was held from the 3rd to 8th November, 1969 and again took the form of an exhibition from 10.00 a.m. to 5.00 p.m. daily at one of the Health Centres in Worth Kensington, a part of the borough particularly at risk to fire and other home accidents. This year it was held at the Lancaster Road Health Centre. Valuable assistance was given by the London Fire Service and the Electricity and Gas Boards, who provided exhibits demonstrating home safety measures in the use of their services. Demonstrations of escape from fire and of resusitation were provided by the British Red Cross Society and emphasis was also laid, with the aid of practical examples, on the dangers of highly inflammable as opposed to non-inflammable wear for children. All schools in the borough were approached and many agreed to display home safety posters before and during the week of the campaign. In some schools, Head Teachers agreed to lectures and film shows on this subject by professional staff of this department. Some pupils took part in a painting competition with home safety as its theme and small monetary prizes were presented to children producing the best paintings. Parties of school children visited the exhibition. Teams of health visitors from each of the Health Centres prepared stands illustrating hazards in the home. The foyer of the Royalty Bingo Hall in Lancaster Road was kindly made available by the management and Health Visitors prepared and attended an exhibition stand to attract the interest of patrons. This stand showed, among other things, items commonly used in the home, which can, if not properly maintained and carefully used, be dangerous. Health Visitors took every opportunity to stress health education topics at the mothers' clubs held at Health Centres; this is also done at ante-natal classes and at the clubs held for elderly persons. Subjects dealt with included infant feeding, psychoprophylaxis, fresh air, sleep and posture, "Home from hospital", cookery and diet, "Keep Fit", bottle feeding, chest health, bathing baby and other related subjects. Co-operation with maternity hospitals At St. Stephen's and St. Mary's (Harrow Road) Hospitals, arrangements were made for Health Visitors to visit the hospitals once a week to talk to recently-delivered mothers on the general theme of "Going Home" and deal with the problems of the first few days after return home with the new baby. 50 Environmental health During the course of their daily duties, public health inspectors take the opportunity to promote health education by informal talks with individuals and small groups. In addition, formal talks are undertaken on request on any subject within their statutory range of duties. During 1969, talks were given to groups which included old people, young mothers, food handlers and hoteliers. Subjects included housing and health, food, hygiene and control of vermin. Accidental hypothermia As in previous years, attention was given to the dangers to the elderly and to very young children from accidental hypothermia. The need to measure body temperature with a special low reading thermometer was specially emphasised. Health education talks and lectures Details of talks and lectures given by departmental staff and other persons to specialised audience groups during 1969 are as follows:- Table 1-Speakers Health Visitors 975 Instructors (ILEA) 31 Other Council Officers 16 Domiciliary Midwives 1 Pupil Midwives 1 Other 145 TOTAL 1169 Table 2 -Subjects Talks Attendances Care of mothers and young children 614 5095 Prevention of accidents 38 932 First Aid 8 161 General Family Health 94 1528 Infectious Diseases 4 59 Work of the Health Visitor 31 461 Venereal Disease 5 72 Care of older children 13 175 Dental health 4 88 National Health Service 12 167 Family Planning 4 38 Smoking and Lung Cancer 5 95 Cancer 2 23 Mental Health 2 23 Work of the Public Health Inspector 1 6 Drug Addiction 1 35 Other 331 3622 1169 12580 51 Table 3 - Audiences Audiences Groups Totals Expectant mothers 494 3099 Over 50's 101 1338 School children 157 3041 Student Nurses 23 314 Student Teachers 8 222 Parents 7 132 Expectant Parents 6 163 Women from Cytology Clinic 1 12 Child care students 1 4 General Public 1 4 Mothers 370 4251 1169 12580 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-nine were issued during 1969, compared with twenty-nine in 1968. 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 Three meetings and two extraordinary meetings of the Borough Co-ordinating Committee were held during 1969. Subjects discussed included the preparation of a manual of guidance for staff on the work of various Services and Departments of the Council and the Inner London Education Authority; the development of in-service training for new members of staff, and the N.S.P.C.C. Battered Child Research Project. The problems of some forty (fifty-five) families causing concern to statutory and voluntary services in the borough were considered at Case Conferences in order to co-ordinate the services already working on their behalf and to consider whether further help was needed. The casework staff has been restored to its full strength during the year with two full-time caseworkers in post at 31st December, 1969; their services continued to be augmented with part-time family casework by the Assistant Principal Social Worker and another social worker. At the 31st December, 1969, 31 families with 125 children (23 families, with 97 children) were being given this kind of support. Close liaison continued to be maintained with the Family Welfare Association and the West London Family Service Unit. Grants made to these two bodies were £1,900 (£1,600) and £3,575 (£3,000). Details of their work in respect of families resident in the borough are as follows:- Family Service Unit Family Welfare Association On 1st January, 1969 Added during year Withdrawn during year on 31st December, 1969 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 56 21 20 57 226 77 66 237 74 79 55 98 151 75 52 174 52 Venereal Disease - This table, although still incomplete, suggests a continuing increase in venereal conditions during the past year. Situation of Clinic Total of all venereal conditions SYPHILIS GONORRHOEA Other venereal conditions Primary and secondary Other Central Middlesex Hospital 1969 1968 1967 1969 1968 1967 1969 1968 1967 1969 1968 1967 1969 1968 1967 * 18 * * nil * * nil * * 2 * * 16 * Dreadnought Seamen's Hospital 6 3 6 nil nil nil 1 nil nil 1 nil nil 4 3 6 The London Hospital 156 137 87 nil nil nil 2 1 3 35 33 21 119 103 63 Middlesex Hospital 1328 1012 801 15 11 nil 19 16 12 282 265 115 1012 723 670 Moorfields Eye Hospital 9 4 * nil nil * nil 2 * nil nil * 9 2 * St. Bartholomew's Hospital 143 * 96 nil * 1 nil nil 29 * 12 114 * 83 St. George's Hospital * * 854 * * 14 * * 8 * * 162 * * 670 St. Mary's Hospital 2454 2258 1852 39 39 22 28 30 16 735 511 499 1652 1678 1315 St. Thomas's Hospital 586 415 386 7 3 1 1 5 2 112 85 71 466 322 312 West London Hospital 3475 * * 16 * * 23 * * 922 * * 251k * * Westminster Hospital 351 249 185 1 4 1 2 nil 2 73 42 23 275 203 159 * Figures not available Section 3 SCHOOL HEALTH SERVICE 53 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, 1936. there is joint use by the Authority and the Council 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 of the borough and is responsible to that Authority for the day-to-day running of the service. The following is a summary of the work of the school health service during the year ended 31st December, 1969. Where relevant, comparable figures relating to the previous year are shown in brackets. At September 1969 there were 9.677 (9.536) pupils attending thirty primary schools and 7.516 (7.520) pupils attending eleven secondary schools. In addition, 160 (173) children attended nursery classes and spastic children of infant age were cared for at Cheyne Hospital School. ROUTINE MEDICAL INSPECTIONS Conditions governing the medical examination of all schoolchildren remain the same as in previous years. Children are examined on entry to infant school at about five years of age, on entry to primary school at about eight, on entry to secondary school at eleven-plus, and finally during the tern immediately preceding the end of their school life. During the year 7381 (6609) children were examined in 771 (778) sessions. The total number of defects found was 2,807, representing an incidence of 38% of the number of inspections. Of these defects 998 (or 13.5% noted for treatment. Vision defects comprised 1219 of the total of which 515 were noted for treatment. SCHOOL MEDICAL INSPECTIONS A child exhibiting hitherto unnoticed physical or mental abnormalities may be specially examined at the request of teachers, parents or other interested parties at any time during school life. Defects discovered at routine medical inspection may also result in special medical examinations. During the year children thought to be in need of education in special schools were referred from various sources and a total of 95 (89) statutory examinations were carried out. Referrals included 67 (83) for the statutory E.S.N. examination which resulted in 33 (45) recommendations for education at schools for the educationally subnormal. The remainder included 15 (14) recommendations for open air schools. Other examinations included 288 (387) secondary school pupils seeking employment and 876 (444) 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 291 (297) children requiring special educational treatment attended schools in other boroughs and 111 (87) were placed in boarding schools. Included in these numbers were 30 (28) physically handicapped children in attendance at day schools and 54 9 (5) at boarding schools. Attending ordinary schools were 69 (70) epileptic children, 46 (87) with orthopaedic and postural defects, 15 (14) suffering from diabetes, 21 (27) from rheumatism, 145 (169) from asthma, 15 (12) cerebral and spastic cases, and 11 (16) with eye diseases other than refractions and squints. The number of maladjusted children referred to the Problem Case Conference was 150 (172). Of this number, 78 (54) were referred to Child Guidance Clinics. There were two tutorial classes for maladjusted children and 10 (30) children were recommended for them from Case Conference. CLINICS Vision Total attendances numbered 1800 (2341) at 163 (172) sessions held during the year. New cases attending during the year numbered 13O8 (1075). Partially sighted children educated in special schools numbered 11 (11). Hearing Audiometry During the year 3676 (4351) children in ordinary schools were given the "Sweep" test by the nursing sisters. Details of the results are shown with the following table:- Boys Girls Total Sweep Test Number tested 1909 1767 3676 Number passed 1724 1625 3349 Number failed 185 142 327 Pure Tone Test of Sweep Test Failures Number tested 111 102 213 Number passed 85 75 160 Number failed and referred to otologist 26 27 53 Other Pure Tone Tests (including Hospital care) Number tested 131 101 232 Number passed 76 56 132 Number failed and referred to otologist 55 45 100 Schools for the deaf were attended by 5 (13) children and partially hearing units by 8 (13); 17 (10) children who wear hearing aids attended various other schools, viz. 9 (5) ordinary schools 2 (2) schools for the physically handicapped and 6 (3) schools for the educationally subnormal. 55 Audiology The total attendances at the 43 (43) sessions held numbered 274 (371). New cases attending during the year totalled 83 (131). In addition, a "deaf" register, reviewed at regular intervals by a designated medical officer, was 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 of whom a number are in boarding schools. Ear, Nose and Throat There were 63 (65) sessions held during the year. Total attendances number 370 (502). New cases attending during the year numbered 39 (141). Special Investigation Children with a wide variety of problems attend the special investigation clinics, where in the main problems of enuresis and over-weight are dealt with. Cases of debility and poor general physique account for most other referrals. At the 114 (120) sessions held, 124 (120) new cases were seen, while the total attendances amounted to 820 (865). Minor Ailments Medical officers conducted 109 (130) sessions and examined 467 (775) new cases. Nursing sisters held 921 (892) sessions and saw 2576 (4945) new cases. Altogether the total attendances at the clinics number 9822 (17351). Speech There were 3(3) clinics staffed by 4 (4) speech therapists with 12 (10) sessions a week. Attendances at the vision, hearing, audiology and ear, nose and throat clinics, as well as at hospital out-patient departments, are arranged through the principal social worker (Health Services). Social workers attend special investigation, audiology and ear, nose and throat clinic sessions and provide the doctor with 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 the child and the family benefit fully from treatment. One of the social workers acts as liaison with the social workers attached to special schools in other boroughs attended by children resident in this borough. PERSONAL HYGIENE Of 14915 (16279) children seen during comprehensive surveys 139 (148) were found to be verminous. Inspections during selective surveys numbered 6004 (4333) and on 168 (112) occasions children were found to be verminous. The number of individual children found to be verminous was 181 (157). 56 BATHING CENTRE Children attend the bathing centre on 458 (344) occasions, when 134 (90) cases of scabies and 228 (114) verminous cases were treated. As in the previous year, no cases of impetigo were treated. There is still clearly a need for vigilance on the part of all concerned. REMEDIAL FOOT CLASSES With the continued co-operation of the head teachers, remedial classes were held in eight primary schools and 256 (216) children were treated by teachers who have attended special classes at the College of Physical Education. Overall supervision was given by a medical officer who visited each class at regular intervals. IMMUNISATION Details of immunisation in schools are given below:- Completed primary courses Reinforcing injections (re-vaccinations) 1969 1968 1969 1968 Smallpox 66 71 135 140 Diphtheria/Tetanus/ Whooping Cough: Triple 27 9 72 82 Diphtheria tetanus 205 186 1,534 1,845 Diptheria 6 4 2 37 Tetanus 13 48 21 25 Poliomyelitis: Salk Nil Nil Nil Nil Sabin 267 292 1,564 1,634 Measles 82 1,208 — - B.C.G. VACCINATION FOR 13-YEAR OLD CHILDREN A medical officer, together with a clerical assistant, visited 4 (8) schools. There were 710 (1018) children eligible for B.C.G. vaccination. The parents of 520 (958) children gave their consent and out of this number 382 (694) were skin-tested and read. Of these 343 (630) children were vaccinated. The remaining 39 (64) were found to be positive reactors. Because of staff shortage the programme started late in the year and this limited the number of schools that could be visited. 57 INFECTIOUS ILLNESS The following table shows the number of cases of infectious illness reported from the schools by head teachers during 1969:- Disease Total Disease Total Chicken Pox 154 Scarlet Fever 12 1 Dysentery ) Diarrhoea ) 16 Sore Throat 4 Enteritis ) German Measles 31 Tonsillitis 36 Influenza 15 Whooping Cough 9 Impetigo 10 Bronchitis 1 Jaundice 6 Virus Infection 1 Measles 47 Ear Infection 1 Mumps 246 Reported Bilious 6 Opthalmia and Glossitis 1 conjunctivitis 9 Gastric Influenza 1 Ringworm (body) 2 Infective Hepatitis 1 Scabies 4 Section 4 DENTAL SERVICES 59 THE DENTAL SERVICES Mr. M.C. Downer Principal Dental Officer STAFF On 31st December 1969, the staff consisted of the principal dental officer and one whole-time and one part-time dental officer supported by four dental surgery assistants,, The vacancies in the professional establishment arose from one of the full-time dental officers reverting to part-time employment and from Miss E. Grivins leaving the Council's service. Our best wishes go with her. We were pleased to welcome Dr. M.K. McCahon to take over sessional duties as anaesthetist in the Borough's dental clinics. TREATMENT The total number of sessions undertaken during the year was lower than in 1968 due in part to staff vacancies occuring during the Autumn and in part to a member of the staff being released for part-time post graduate education during the first half of the year. Reductions will thus be seen in the total number of attendances and in the volume of treatment carried out. Sessional averages show little variation from the previous year however. DENTAL HEALTH EDUCATION Details are included in the section on health education. COURSES AND CONFERENCES The principal dental officer completed the post graduate course in dental public health of the University of London and was successful in the final examination for the Diploma in Dental Public Health of the Royal College of Surgeons. The principal dental officer also visited the Annual Conference of the British Dental Association in Bournemouth for one day. SCHOOL DENTAL INSPECTIONS AND SPECIAL INVESTIGATIONS OF DENTAL DISEASE PREVALENCE. Fifteen infant schools and departments, twelve junior schools and departments and eight senior schools received routine dental inspections during the year. In addition to providing a screening examination to detect children in need of dental treatment, three school dental inspections were used as an opportunity for more detailed assessments of the levels of various dental diseases and conditions in children of different age groups. Although the groups examined were not a true representation, from a statistical point of view, of all children within these age groups in the Borough, the information obtained is none the less of value as an objective indication of the likely state of dental health of those in particular areas. The data were collected under standardised conditions using standardised examination methods recommended by the World Health Organisation. 60 In the first survey, an examination of 52 five-year-old boys and girls in an infant school in an area of high socio-economic status in Kensington, revealed an average of 2.1 decayed, extracted or filled (d.e.f.) temporary teeth per child. 170 boys and girls aged 7 to 11 years, comprising the junior department of the same school had an average of 1.4 decayed, missing,, or filled (D.M.F.) permanent teeth per child. In the second survey, an examination of 45 girls aged 10 and 11 years, comprising the senior girls' classes of another primary school in the same area, showed that 11 (approximately 25 per cent) had orthodontic conditions requiring correction. All these children would have benefited, from the point of view of appearance or function, from treatment, but it was interesting to note that only one child was actually wearing an orthodontic appliance at the time. It might be expected that the parents of children in this district would have sought treatment for this type of condition, though the general scarcity of facilities for orthodontic treatment in all three branches of the health service may have had a bearing on the high prevalence of un-treated cases. The third survey involved a comparision of dental decay and diseases of the gums in 373 girls aged 11 to 14 years in e senior school in an area of relatively lower socio-economic status in North Kensington. Over one-third of the children examined were immigrants, mostly of West Indian origin. In the 13 and 14 year old age range (182 girls) the Europeans in the school had an average of 5.90 D.M.F. teeth and the negroes an average of 4.67, and the percentage of European girls who had experienced dental decay at some time (96%) was significantly higher than the percentage of negroes (77%). A statistical comparison of the ratios of restored teeth to the total number of teeth showing evidence of attack however, indicated that the negro girls made relatively less use of the available local dental services than the Europeans and probably had a less favourable attitude to conservative dental treatment. The prevalence of diseases of the gums was ascertained for the full sample of 373 girls, and although it was found that the overall proportions of girls in the European and negro groups showing unmistakable evidence of inflammation of the gums (gingivitis) was nearly the same (around 79%) a significantly higher proportion of the negro group (45% compared with 24% for the Europeans) showed evidence of gingival inflammation which had progressed to destruction of the bone supporting the teeth (periodontitis). The higher prevalence of past and present dental decay in the Europeans was probably accounted for by a greater amount of sugar in their diet, while the greater severity of gum diseases in the negroes probably resulted from a poorer standard of oral hygiene. Comparison of the figures for dental disease levels obtained in these surveys with available information on national averages should be made with caution, since the methods used in the collection of officially quoted data were not necessarily the same. The diagnosis of dental diseases is notoriously subject to great examiner variation and official data are collected from many independent sources. - 61 - It is intended to build up a baseline of objective information on dental disease levels in the various age groups in all schools in the Borough eventually, so that future disease levels can be compared with these findings. School Dental Service Kensington and Chelsea 1969 1968 Number of sessions Inspection 95.0 106.6 Ordinary treatment 1,220.0 1,360.7 General anaesthetic 21.1 17.0 Health education 9.0 11.0 Total sessions 1,345.1 1,495.3 Inspections: Number of children given First inspection at school 7,248 8,469 First inspection at clinic 2,291 1,872 Percentage found to require treatment 58.4 67.2 Reinspection at school or clinic in 1969 1,687 1,555 Percentage found to require treatment 49.2 57.0 Total of appointments made 14,102 15,662 Total of attendances by appointment 9,146 9,808 Response rate 64.8% 62.5% Average attendances per session 7.6 7.2 Visits for treatment: Number of first visits 2,910 2,875 Number of subsequent visits 5,273 6,106 Total visits 8,183 8,981 Emergencies 177 181 Additional courses commenced 419 472 Treatment given: Number of fillings In permanent teeth 3,757 4,305 In temporary teeth 2,835 3,772 Number of extractions Of permanent teeth 247 199 Of temporary teeth 1,040 916 Number of other operations (prophylaxis, X-rays, inlays, crowns, etc.) 2,232 2,769 Courses of treatment completed 2,670 2,416 Orthodontics: Number of new cases 10 20 Number of removable appliances fitted 11 18 Number of fixed appliances fitted Nil - - 62 - MATERNITY AND CHILD WELFARE DENTAL SERVICES During the year an increased amount of treatment was provided; the number of fillings inserted for the under fives showing particularly a considerable increase over the previous year. Five nursery schools and nursery departments of infant schools were inspected during the year and follow-up treatment was also provided for some children from the Junior Training Centre for the mentally handicapped which had also received an inspection. As is usually found in such patients, the general level of oral hygiene was very poor, resulting in a high prevalence of established gum diseases. In the patients treated, the management problems were not so severe as to preclude treatment without recourse to general anaesthesia and they were taken by minibus to the Walmer Road Centre for the purpose. A talk on dental health education illustrated with a film, for the mothers' club at Walmer Road Centre, was well attended. It is hoped that the appointment of a dental auxiliary to the Borough's dental service will result in an extension of such activities, and will also enable greater use of preventive applications of fluoride solutions to the teeth of under fives to be made. Fluoridation of the Borough's water supplies is still delayed. Nursing or expectant mothers Children under five 1969 1968 1969 1968 No. of appointments 195 164 1,463 1,634 No. of attendances: By appointment 137 118 1,052 1,176 Other 4 Nil 11 19 No. of patients given first inspections during year 34 34 472 526 No. of patients above found to suggest 32 33 250 263 medical treatment No. of patients above offered treatment 27 33 244 260 Visits for treatment: First 41 34 232 248 Subsequent 82 65 435 576 No. of treatments given: Fillings 108 6l 424 189 Teeth extracted 19 36 81 26 Patients X-rayed 9 9 1 8 Prophylaxis (patients) 21 23 21 30 No. of courses of treatment completed 29 14 183 244 No. of patients supplied with dentures (F.U. or F.L) first time 4 Nil No. of patients supplied with other dentures 4 6 No. of dentures supplied 10 7 1969 1968 Total sessions in year (combined) 122.1 143 Section 5 MENTAL HEALTH SERVICE - 63 - MENTAL HEALTH SERVICE Mr. K. Chambers Principal Mental Welfare Officer For the year under review the total number of referrals to the mental health service was 1291. This compares with 1268 referrals for 1968. From these almost identical figures it would appear that there has been a levelling off in the previously fluctuating pattern of referrals since 1965. This is reflected in the continued intensive casework and community care provided by the mental welfare officers. Staff Since the last report Mr. D. T. Baldwin who as Principal Mental Welfare Officer was responsible for inaugurating the Borough's mental health services in 1965 has retired. The staff remained unchanged during 1969 and consists of principal mental welfare officer, deputy principal mental welfare officer, seven senior mental welfare officers, three mental welfare officers and two trainees. One officer attending the Sheffield College of Technology was awarded the Certificate in Social Work on completing the two-year course and another officer is undertaking a similar two-year course at the Chiswick Polytechnic. During the past year members of the staff have attended short courses and seminars arranged by London Boroughs' Training Committee. As in the two previous years a student from Bedford College of the University of London spent a month in the department in order to gain practical experience in social work whilst studying for the Diploma in Social Studies. Psychiatric Day Centre The centre continues to supply a need for the mentally ill and has an average daily attendance of 18 persons. The activities of the group are varied and consist of light industrial work and a selection of homecraft and handicraft activities. A Drama Therapist and a Craft Instructress from the North Kensington Evening Institute visit the centre for one half day session per week each. It has been noted that patients have responded to these additional activities and have benefited accordingly. Admissions to Hospital Of the 1291 persons referred during the year 4l4 were admitted to hospital by mental welfare officers under the statutory provisions of the Mental Health Act, 1959 and of these 119 were admitted informally. Many informal admissions are effected by arrangement between the catchment hospital concerned and the patient's G.P. without recourse to the services of the department. - 64 - Community Care During the year mental welfare officers initially visited 986 persons. The number of visits made to individual patients varied according to their needs. The average case load for officers at 31st December 1969 was 56.2 and includes the mentally ill and mentally subnormal. Social Club The Psychiatric Social Club which was run under the auspices of the Notting Hill Social Council had unfortunately to close as they were unable to provide social worker supervision. At the beginning of 1969 it was felt that an additional psychiatric social club was required in North Kensington and this was started by the Council's mental welfare officers on the premises of the Junior Training Centre. This club has proved successful and in addition to indoor activities, an outing to Brighton during the summer and an evening visit to the theatre were organised. These outings were much enjoyed. Mentally Subnormal During the year 97 new cases were referred for action, e.g. community care, residential care or attendance at the training centres. The special clinic for children under five years of age continues and twenty-three examinations were carried out during the last twelve months. Residential Care Long term residential care has been authorised for 41 persons who were mentally ill or subnormal. In a further 27 cases short term care was arranged to provide relief to parents and relatives from the strain of caring for the mentally subnormal. Training Centres Formal educational methods continue to be used throughout the Junior Training Centre and at each level suitable children are being taught to read and write. At the Adult Training Centre progress has also been maintained in the teaching of reading and writing. Emphasis is however placed on social training to enable the trainees to become more self reliant and take their place in the day to day life of the community. The annual holiday at Dymchurch, New Romney, was held during May 1969 and Mr. R.F. Potter, Supervisor of the Adult Training Centre was again in charge of the camp. - 65 - An important step in the life of the Adult Training Centre was the integration of fourteen female trainees who previously attended two other local authority Training Centres. This became necessary as the London Borough of Wandsworth whose centre they were attending wished to use their places. The girls have settled down well and the innovation has proved very successful. Since the last report construction has started on the combined adult training centre and psychiatric day centre which is to be erected at 1-9 St. Mark's Road, W.ll. Planning of the necessary equipment which will be required in the centres is well advanced as it is anticipated that the building will be operative in the autumn of 1970. Special Unit for Subnormal Children The Unit which is attached to the St, Quintin Day Nursery receives retarded children between the ages of three and five years. Full use of the facilities afforded by this Unit have been made throughout the year. Notting Hill Neighbourhood Service During the course of the year arrangements were made with the Notting Hill Neighbourhood Service to appoint an officer from the Borough to act in an advisory capacity with the object of promoting and conducting effective liaison with this voluntary organisation. As the number of referrals from the Neighbourhood Service appeared to show a preponderance of psychiatric problems, Mr. Ashbridge, Mental Welfare Officer was appointed from this department, This contact has been of value in the interchange of information between the organisation and the appropriate departments of the Council. - 66 - MENTAL HEALTH STATISTICS 1969 Quarter Ended Total 1969 Total 1968 29.3 28.6 27.9 27.12 1. Numbers referred by (i) Hospitals (in-patients) 101 80 93 82 356 361 (ii) Hospitals (outpatients) 49 60 42 44 195 189 (iii) General practitioners 57 52 61 42 212 221 (iv) Police or Courts 11 10 5 6 32 21 (v) Other non-medical 148 116 137 95 496 476 TOTALS 366 318 338 269 1,291 1,268 2. Mental category of above (i) Mentally ill 340 294 315 245 1,194 1,162 (ii) Subnormal or severely subnormal 26 24 23 24 97 105 (iii) Psychopathic Nil Nil Nil Nil Nil 1 3. Initially admitted to hospital (i) Informally 48 30 18 23 119 140 (ii) Compulsory Section 25 (observation) 46 55 64 23 188 162 Section 26 (treatment) 9 6 5 4 24 31 Section 29 (emergency) 19 20 25 18 82 88 Other Nil Nil Nil 1 1 4 TOTALS 122 111 112 69 414 425 4. Final Disposals (including patients initially admitted to hospital) (i) No further action 153 118 131 110 512 446 (ii) Hospital care 122 111 112 69 414 425 (iii) Community care 107 75 97 75 354 355 TOTALS 382 304 340 254 1,280 1,226 5. Community Care Under care 31.12.68 Referred during 1969 Withdrawn from care 1969 Under care 31.12.69 622 354 189 787 MENTAL HEALTH STATISTICS 1968 MENTALLY ILL SUBNORMAL SEVERELY SUBNORMAL TOTALS -16 16+ Elderly -16 16+ Elderly -16 16+ Elderly M F M F M F M F M F M F M F M F M F Individuals under L.H.A. care at 31st December, 1968 2 2 157 218 10 64 20 18 32 46 10 13 16 14 622 Number of referrals during 1969 9 4 430 603 26 122 24 15 21 20 1 2 6 4 4 1,291 First Referrals Total during year 8 4 323 445 21 99 22 14 20 17 1 2 5 2 3 986 Total known in previous year(s) 1 1 94 129 7 27 5 1 8 3 1 1 1 2 281 Number of individuals referred once only during year 7 4 268 351 18 92 20 13 19 14 1 1 4 2 814 Subsequent referrals - during year 1 107 158 5 23 2 1 1 3 1 2 1 305 Total known in previous year(s) 54 80 2 11 1 1 1 1 2 1 154 Second referrals Total during year 1 72 113 4 15 2 1 1 3 1 2 1 216 Total known in previous year(s) 35 54 1 7 1 1 1 1 2 1 104 Number of individuals referred twice during year 1 55 94 3 7 2 1 1 3 1 2 1 171 Third referrals Total during year 22 31 1 8 62 Total known in previous year(s) 13 17 1 4 35 Number of individuals referred three times during year 17 19 1 8 45 Fourth referrals Total during year 8 13 21 Total known in previous year(s) 3 9 12 Number of individuals referred four times during year 5 12 17 Referrals over four years Total during year 5 1 6 Total known in previous year(s) 3 3 Number of individuals referred over four times during year 3 1 4 Section 6 ENVIRONMENTAL HEALTH SERVICES - 67 - SANITARY ADMINISTRATION OF THE BOROUGH Mr. D.C. Draper Chief Public Health Inspector For the purpose of the routine inspection of premises and the investigation of complaints, the borough is divided into four areas. The overall supervision of each area is the responsibility of a senior public health inspector. The four areas are sub-divided to form twelve districts, nine of them coinciding with the nine wards in Kensington and each of the three remaining districts consisting of two of the smaller wards in Chelsea. The twelve public health inspectors allocated to these districts are assisted by three technical assistants and two drainage assistants. Considerable importance is attached to the training of student public health inspectors, which is undertaken in conjunction with the two technical colleges in London. The present establishment of trainees is seven. The employment in the department as public health inspectors of students who are successful in obtaining the Examination Board's Diploma serves to fill the majority of the vacancies which occur by reason of officers leaving to take up positions with other authorities. In addition to the inspectors engaged on district duties, eight inspectors are allocated to housing, one to the operation of smoke control areas, one to duties in connection with the Offices, Shops and Railway Premises Act, 1963 and a further inspector to the specialist duties in connection with the sampling of food and drugs. The work of rodent control is undertaken by a rodent officer and six assistants. The disinfection and disinfestation work, and the other services which are provided at the Medicinal Baths in North Kensington, are undertaken by the Chief Disinfector and six assistants. At the end of 1968, the majority of the work of the Public Control Section, previously undertaken by officers in the Town Clerk's Department, was transferred to the Health and Welfare Department. A senior inspector and two assistants were transferred to this department and, as far as possible, the work of the section has been integrated with that of the public health inspectors. - 68 - 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) 2,763 Infectious disease 856 Smoke observations 30 Other inspections 2,499 Re-inspections 5,672 Housing Acts. 1957 to 1964 Houses in multiple occupation (house-to-house) 372 Slum clearance (house-to-house) 167 Underground living rooms 481 Overcrowding 313 Other inspections (loans, grants, etc.) 411 Re—inspections 7,821 Clean Air Act. 1956 Total number of visits 2,171 Factories Act. 1961 Premises inspected 286 Outworkers' premises inspected 42 Other visits 28 Offices, Shops and Railway Premises Act, 1963 Total number of visits 1,750 Drainage Applications received (plans submitted) 399 House drains inspected 4,629 House drains tested 338 Notices Served Public Health Acts. 1936 and 1961 Intimation notices 510 Statutory notices 334 Final notices 49 Housing Acts. 1957 to 1964 Section 9 (repair) 83 Section 14 (deficiencies of management) 14 Section 15 (additional amenities) 56 Section 16 (means of escape from fire) 67 Various Food hygiene (General) Regulations, 1960 69 Offices, Shops & Railway Premises Act, 1963 51 Other notices 27 - 69 - Work Completed House drains, reconstructed or repaird 76 House drains cleansed 100 Water closets, reconstructed or repaired 50 Water closets, new provided 169 Soil pipes, vent pipes,. repaired, etc. 39 Soil pipes, vent pipes, new provided 43 Baths, new provided 154 Sinks, new provided 151 Lavatory basins, new provided 61 Bidets, new provided 5 Waste pipes, new provided 122 Cisterns cleansed 21 Dustbins provided 87 Accumulations of filth, etc., removed 203 Roofs, gutters and rainwater pipes repaired 272 Dampness in dwellings remedied 154 Artificial lighting to staircases provided 78 MEDICINAL BATHS - PERSONAL CLEANSING STATION The following table shows the work carried out during 1969:- Description Scabies Vermin Persons Cleansings Persons Cleansings Adults Kensington & Chelsea 137 225 208 234 Other boroughs - - - — Schoolchildren Kensington & Chelsea 106 184 149 149 Other boroughs 31 44 74 74 Children under five Kensington & Chelsea 25 43 33 33 Other boroughs — — — — TOTALS 299 496 464 490 In addition to the cleansing of persons referred to above, the number of articles disinfested at the medicinal baths during the year numbered 373. DISINFECTION AND DISINFESTATION A summary of the routine work carried out in 1969 by the disinfecting staff is shown in the following table:- Houses disinfected after infectious disease 63(112 rooms) Houses disinfested after vermin 818 (1649 rooms) Total weight of bedding, etc. dealt with 4¾ tons - 70 - Certain foreign countries prohibit the import of parcels of clothing, unless accompanied by a certificate that the articles have been disinfected, The Council afford facilities to person desirous of sending clothing abroad and, for this service, a standard charge is made of 10s. 0d. per pareel. During the year, fifty-one parcels of clothings were disinfected and the income amounted to £25 10s. 0d. The following table indicates the destination of these parcels: Destination No. of parcels Argentina 3 Czechoslovakia 1 East Germany 16 Iceland 1 Romania 6 Spain 24 TOTAL 51 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, 1969 as follows: Treatment of premises (rats and mice) Number of properties in the borough 75,438 Total number of properties inspected following notification 2,050 Number infested by rats 34 Number infested by mice 1,917 Total number of properties inspected for rats and/or mice for reasons other than notification Nil Number infested by rats Nil Number infested by mice Nil - 71 - 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 2,165 Premises where rats were found 34 Premises where mice were found 1,917 Premises where other vermin were found 99 Number of visits made 21,772 Number of successful treatments 1,772 Cases in which advice only was given 278 Borough Council properties dealt with (excluding dwewlling houses) 40 FERTILISERS AND FEEDING STUFFS ACT. 1926 On 1st April, 1965, the 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 samples of fertilisers and one sample of feeding stuffs were obtained and submitted for analysis in accordance with the provisions of the Act. The composition of three samples of fertilisers and the sample of feeding stuffs were found to vary beyond the prescribed limits, and in each case the matter was taken up with the supplier concerned. 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. 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 the 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 provided 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. - 72 - 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 101. There were three 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 Two Pounds. At the end of the year, there were twenty-one registered premises in the borough. 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 five under mentioned samples of rag flock and other fillings were taken for analysis and were reported to be satisfactory:- Description No. of samples Black Algerian Fibre 1 Grey Algerian Fibre 1 Unused Cotton Felt 1 Rag Flock 2 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 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. - 73 - ATMOSPHERIC POLLUTION Smoke Control Areas During the year, the Council decided to make a Smoke Control Order in respect in those parts of St. Charles and Golborne Wards bounded on the north by the borough boundary,, on the east by the borough boundary, on the south by the centres of North Pole Road, St. Quintin Avenue, Chesterton Road, Portobello Road and Lancaster Road, and on the west by the borough boundary» It has an area of approximately 356 acres (map reference No. 13). The detailed survey showed that the total cost of adaptation will be approximately £58,910 of which, after deducting Exchequer Grant and the cost for which private owners will be responsible, the Council will be responsible for payments amounting to £22,365. The Order was made on 22nd July, 1969 and was confirmed by the Minister of Housing and Local Government on 29th October, 1969, and cited as the St. Charles and Golborne Smoke Control Order, 1969° The date of operation will be 1st October 1970. The requirements of the Smoke Control Order extend to the smokeless ignition of authorised solid fuels and there is little doubt that the best method of achieving this is by gas0 For those buildings or separately occupied parts of buildings which are without a gas supply, an exemption may apply so that sticks and paper may be used for kindling purposes provided an authorised fuel is used0 Provision for such an exemption is included in the Order. Smoke Control Area Map Ref. Boundaries Order operative Holland Ward (No. 1) Holland Ward (No. 3) Church Ward 1 3 ci N. Holland Park Avenue E. Campden Hill Road S. Kensington High Street W. Abbotsbury Road N. Notting Hill Gate E. Borough boundary S. Kensington High Street W. Campden Hill Road Church Ward boundaries 1.10.1959 1.10.1960 1.11.1960 _ 74 - Smoke Control Area Map Ref. Boundaries Order Operative Holland Ward (No, 2) Pembridge Ward (No, 1) Pembridge Ward (No, 2) Hans Town Ward Norland Ward (No. 1) Norland Ward (No. 2) Cheyne and Royal Hospital Wards Earls Court and Queen's Gate Wards Earls Court Redcliffe and Brompton Wards Redcliffe and Brompton Wards Brompton and Queen*s Gate Wards 2 4 5 C2 6 7 C3 8 9 10 11 N, Holland Park Avenue E. Abbotsbury Road S. Kensington High Street W. Borough boundary N. Westbourne Grove E. Borough boundary S. Nottlng Hill Gate W. Ladbroke Grove N. Lancaster Road E. Borough boundard S. Westbourne Grove W. Ladbroke Grove Hans Town Ward boundaries N. Lancaster Road E. Ladbroke Grove S, Holland Park Avenue W. Walmer Road and Princedale Road N. Lancaster Road E. Walmer Road and Princedale Road S. Holland Park Avenue W. Borough boundary Cheyne Ward and Royal Hospital Ward boundaries N, Kensington High Street E. Palace Gate and Gloucester Road S. West Cromwell Road W. Borough boundary N« Cromwell Road and West Cromwell Road E, Queen's Gate S. Old Brompton Road W. Borough boundary N. Old Brompton Road E. Onslow Gardens and Neville Terrace S. Fulham Road W. Borough boundary N. Borough boundary E. Hoopers Court S, Fulham Road, Draycott Avenue Walton Street, Walton Place and Basil Street W. Palace Gate, Gloucester Road Queen's Gate, Onslow Gardens, Neville Terrace and Cromwell Road 1.10.1961 1.10.1961 1.10.1962 1.11,1962 1.10.1963 1.10.1964 1.7.1965 1.10.1965 1,10„1966 1.10.1967 1.10.1968 75 Smoke Control Area Map Ref. Boundaries Order Operative St. Charles Ward (No, 1) 12 N. Centres of North Pole Road, St. Quintin Avenue and Chesterton Road E. Centre of Portobello Road S. Centre of Lancaster Road W. Borough boundary 1,10.1969 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-two notifications were received and in each case there was no objection to the proposals submitted„ The St. Charles No. 1 Smoke Control (Variation) Order 1969 Enquiries made in respect of a number of dwellings within and close to the Silchester Estate revealed that the Greater London Council may make them subject to redevelopment within the next few years. The dwellings are, generally in poor order and it seems likely that some definite proposals will be made in the near future. In order to avoid unnecessary expenditure on fireplace adaptations it was decided to exempt these buildings from the effects of the St« Charles No. 1 Smoke Control Order, 1968, This Variation Order came into operation on 1st October, 1969° Smoke Nuisances During the year, 58 complaints of smoke nuisance were received and 36 formal smoke observations were carried out. Successful legal proceedings were instituted in three cases and remedial measures in the remaining cases were secured informally. 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 prepared:- 76 *Sites Smoke (Microgrammes per Cubic Metre Sulphur Dioxide (Microgrammes per Cubic Metre) MonthlyAverage Highest DailyReading Monthly Average Highest Daily Reading A B C D A B c D A B A B 1968 July 37 28 68 31 114 68 94 48 142 100 360 200 August 33 30 59 32 70 61 91 50 101 99 260 348 Sept. 43 35 74 41 128 69 123 65 136 128 431 400 October 50 54 98 67 157 166 226 153 201 202 717 625 Nov. 73 71 156 80 167 146 283 145 307 305 573 598 Dec. 109 102 N N 229 286 418 232 412 436 1277 1203 1969 Jan. 65 78 132 88 210 225 268 236 329 353 678 646 Feb. 73 64 129 84 198 186 200 172 381 371 594 719 March 84 67 140 88 175 141 231 137 427 418 881 1030 April 132 33 70 39 442 153 187 72 212 234 353 780 May 37 28 73 N 93 6l 155 88 203 183 605 364 June 35 24 68 N 63 49 120 51 138 141 348 330 "N" - level of readings insufficient to obtain accurate measurement: Site address: A - Chenil Galleries, King's Road, S.W.3. B - The Red House, Hornton Street, W.8. C - Public Library, Lancaster Road, W.10. D - Child Health Centre, Redcliffe Street, S.W.10 (Sites C and D have smoke measuring apparatus only) NOISE ABATEMENT ACT. 1960 Sixty-two complaints concerning alleged noise nuisances were received, thirty-seven fewer than during the previous year, 68% of the complaints related to noise caused by industrial works, road works (use of pneumatic drills, and compressors, etc.), building operations and miscellaneous plant and machinery in commercial premises. Noise caused by neighbouring residents in private dwellings accounted for 11% of the total complaints received and the remaining 21% concerned noise from pop groups, clubs and animals, etc. All the complaints were thoroughly investigated and, in the majority of cases, an approach to the offending contractors or firms resulted in the fullest co-operation and assistance being given to implement suitable noise reducing methods. In five cases there was no health nuisance and in the remaining cases remedies were secured without recourse to legal action. In the few cases where complainants were not satisfied with the action taken by the officers of the Health Department their rights under private action were explained to them. 77 BYE-LAWS AS TO THE ARTIFICIAL LIGHTING OF COMMON STAIRCASES IN TENEMENT HOUSES AND FLATS The Council's Bye-laws relating to artificial lighting of common staircases in tenement houses and flats were made on 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. During 1968, formal notices were served in fifteen instances, requiring compliance with these Bye-laws. 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 Secretary of State for Employment and Productivity in Circular No. 1/70. Part 1 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 32 9 1 (ii) Factories not included in (1) in which Section 7 is enforced by the local authority 624 241 17 - (iii) Other premises in which Section 7 is enforced by the local authority (excluding outworkers' premises) 38 36 - - TOTAL 694 286 18 - 78 2. Cases in which DEFECTS were found: (If defects are discovered at the premises on two, three or more separate occasions they should be reckoned as two, three or more "cases"). Particulars (1) Number of cases in which defects were found No. of cases in which prosecutions were instituted (6) Found (2) Remedied (3) Referred To H.M. Inspector (4) By H.M. Inspector (5) Want of Cleanliness (S.l) 5 5 - 4 - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) — - — — — Inadequate ventilation (s.4) - — - - — Ineffective drainage of floors (S.6) — - - — - Sanitary conveniences (S.7) (a) Insufficient 2 - - - - (b) Unsuitable or defective 23 21 _ 5 - (c) Not separate for sexes - - - - - Other offences against Act (not including offences relating to Outwork) _ - _ - - TOTAL 30 26 - 9 - 79 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 12 - - - - - Curtains and furniture hangings 5 - - - - - Artificial flowers 1 - - - - - Boxmaking 7 - - - - - Feather sorting 6 1 - - - - Packing of glass fibre rods in cellophane 1 - - - - - TOTALS 32 1 - - - — During the year, 274 inspections were made of outworkers' premises, comprised of those shown in the February and August lists for the year, together with all those notified in previous years. This was done to ascertain whether the premises were still being used for outwork. No infectious disease was reported from any premises where home work was carried on. 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 latest quinquennial review was carried out in 1968, and at the present time there are nine basement bakehouses in use in the borough, as follows:- 151 Earls Court Road 178 Fulham Road 323 Fulham Road 65 Golborne Road 79 Golborne Road 134 King's Road 517 King's Road 139 Portland Road 46 Walton Street 80 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 responsiblity, 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 responsbile for inspecting premises owned or occupied by the Crown and those occupied by local authorities. Provisions relating to fire precautions are the responsiblity 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 ses receiving general inspections during the year Offices 63 1,033 311 Retail shops 27 1,356 152 Wholesale shops, warehouses 2 54 7 Catering establishments open to the public, canteens 27 466 144 Fuel storage depots - - - TOTALS 119 2,909 614 Number of visits of all kinds (including general inspections) to registered promises 1,750 81 Analysis by workplace of persons employed in registered premises at end of year Class of Workplace Number of persons employed Offices 15,692 Retail shops 12,664 Wholesale departments, warehouses 943 Catering establishments open to the public 5,181 Canteens 332 Fuel storage depots - TOTAL 34,812 TOTAL MALES 16,471 TOTAL FEMALES 18,341 Summary of Contraventions Section of Act Contraventions found during general inspections and routine visits made by the Public Health Inspectors Section 4 Cleanliness 10 Section 6 Temperature 72 Section 7 V entilation 23 Section 8 Lighting 8 Section 9 Sanitary conveniences 10 Section 10 Washing facilities 10 Section 12 Accommodation for clothing 2 Section 13 Sitting facilities 1 Section 16 Floors, passages, and stairs 5 Section 24 First-aid 35 Section 49 Notification of fact persons are employed 92 Section 50 Information for employess 82 TOTAL 350 82 Workplace Number reported Total number Investigated Action recommended 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:- Fatal Non Fatal Prosecution Formal warning Informal advice No action Offices - 15 - - - - . Retail shops - 85 2 - - 2 - Wholesale shops and warehouses - 5 - - _ - - Catering establishments open to the public, canteens - 15 - - - - - Fuel storage depots - - - - - - - TOTALS - 120 2 - - 2 — Causes of accidents Offices Retail shops Wholesale shops, Warehouses Catering establishments open to the public, canteens Fuel storage depots Machinery 2 4 - 1 - Transport - 1 - - _ Falls of persons 4 20 1 8 _ Stepping on or striking against object or person 3 14 - - - Handling goods 3 31 4 3 - Struck by falling object 1 6 - - - Electrical - 1 - - - Use of hand tools - 6 - 1 - Not otherwise specified 2 2 - 2 - 83 Comparison of Causes of Accidents Primary Cause 1967 1968 1969 RBK & C England RBK & C England RBK & C % % % % % Machinery 4.85 4.90 7.00 5.1 5.8 Transport 4.24 4.00 5.80 4.6 1.6 Falls of persons 23.60 38.7 30.20 36.9 28.3 Fires & Explosions 1.20 0.60 1.20 0.7 - Electricity - 0.40 - 0.30 0.83 Use of hand tools 10.80 6.10 7.00 5.6 5.80 Stepping on or striking against an object or person 12.10 10.10 16.30 9.5 14.10 Handling goods 36.3 21.10 26.20 22.8 35.00 Struck by falling object 1.80 5.80 4.00 5.90 5.80 Not otherwise specified 4.85 8.40 2.30 8.50 5.00 OFFICES. SHOPS AMD RAILWAY PREMISES (HOISTS AND LIFTS) REGULATIONS. 1968 These Regulations, which came into force on 28th May, 1969, impose requirements as to the construction, maintenance and examination of hoists and lifts in offices, shops and catering establishments which are registrable under the Act of 1963. Every lifts must be examined by a competent person every six months (under six months in the case of a continuous lift and a lift not connected with mechanical power), The competent person is usually an engineer employed by or on behalf of an insurance company. If the lift cannot be used with safety, a copy of the engineer's report is sent to the authority responsible for enforcing the Regulations. During the six months of operation of the Regulation, twentynine such reports were received. Lifts in registrable premises within the Borough were listed during 1968, and it was found that many proprietors of restaurants were unaware of their obligations under the Regulations. The half-yearly inspection of a lift by a competent person does not relieve the Council's inspectors of duties relating to the matter of safety and the enclosing cf lifts which are absolute requirements of the principal Act, and the Regulations, and it is expected that in the final few years of the operation of the Regulations that inspectors will have to make many recommendations in connection with these matters. LAND CHARGES The number of land charge enquiries dealt with during the year was 6,081 compared with 5,719 in 1968. These concerned outstanding statutory or informal notices, closing orders, smoke control orders, certificates of disrepair, slum clearance, etc. 84 TOWN PLANNING APPLICATIONS During the year, 1,558 applications were referred to the Health Department for observations, compared with 1,352 in 1968. 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 & 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 One hundred and ninety one copies of applications to the Licensing Justices (restaurant or residential 133, clubs 24 and public houses 54) for 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. In addition to the above, 27 copies of applications in respect of Off-Licences were received and the premises were inspected to ensure that they complied with the Food Hygiene (General) Regulations, 1960 and the Offices, Shops and Railway Premises Act, 1963. LICENCES FOR PUBLIC ENTERTAINMENT During the year, 4 copies of applications for music and dancing licences from the Greater London Council were referred to this department for reports of any actual complaints on the grounds of noise nuisance received from local residents. No complaints were made to this department, but the Greater London Council received a number of complaints in respect of one of the premises. GREATER LONDON COUNCIL (GENERAL POWERS) ACT.1968 Night Cafes The Borough Council adopted the provisions of Part VIII of the above Act and fixed the appointed day as 2nd June, 1969 and from that date no premises in the Borough may be used as a night cafe without being registered with the Council under the Act, The registration must be renewed every year. The term "night cafe" means any premises kept open for refreshment at any time between the hours of 11.00 p.m. and 5.00 a.m. whether for use by the public or by a club, organisation or body, except that public houses, theatres, cinemas, hotels, guest houses, specified licensed premises or used for charitable purposes or as a sports club or staf canteen are excluded from this definition. Any person whose night cafe operates without being registered after the 2nd June 1969, is liable to a fine of up to £200 or three months' imprisonment or both. However, any person using premises a night cafe who applied for registration before the 2nd June, 1969. was allowed to continue to use the premises for the purpose after that date until informed of the Council's decision with regard to his application. 85 Any person applying for registration of premises or for renewal of registration as a night cafe must pay to the Council a fee of £1 and give public notice in the prescribed manner drawing attention to the right of members of the public to object to the registration. The Council, before making a decision as to registration or the renewal of registration have to consider, amongst other things, the structural suitability of and the facilities available at the premises, the manner in which the night cafe is conducted and the possibility of nuisance being caused to neighbours late at night. If the Council are not satisfied about any of these matters they may refuse to register or renew registration of the premises. he Council also has power when registering the premises or renewing registration to impose conditions as to precautions to be taken for the safety of person using the premises, as to the conduct of the premises and as to the hours at night during which the night cafe may be kept open. The Council may, at any time revoke the registration if any such conditions imposed therein are broken and the person responsible for the breach may be prosecuted. There are rights of appeal to the Courts from the decision of the Council in respect of an application for registration. It is also an offence under the Act for a night cafe to be conducted in a disorderly manner or for certain specified drugs to be sold, supplied or distributed on the premises. Seventy-three applications for registration were received, but of these only fourty-four were from premises eligible for registration. Eleven applications were still under consideration at the end of the year. Four applications were refused by the Council. Kensington Police reported four unregistered premises which were being used as night cafes after 11.00 p.m., and the Council prosecuted the proprietors, all were found guilty and the total of the fines amounted to £115. REFRESHMENT HOUSES ACTS, 1860-1967 Under the Refreshment Houses Act 1860-1967, a refreshment house licence is required for any shop or ocher premises not licensed for the sale of intoxicating liquor, but which is kept open for public refreshment or resort at any time between 10.00 p.m. and 5.00 a.m. except premises where the provisions of the Greater London Council (General Powers) Act, 1968-Part VIII apply. A licence is needed in respect of refreshment rooms which form part of the premises used for public entertainment and resort, for example, Cinemas, Skating Rinks, etc., (if kept open for public refreshment during the hours mentioned). Licences commence on 1st April and expire one year later. The fee is £l 1s Od. In the case of a first application, licences are issuable from 1st July (fee 15s 9d) from 1st October (fee 10s 6d) and 1st January (fee 5s 3d.) 86 The Council has decided to impose the following conditions on the issue or renewal of all licences. It shall not be lawful to make any charge for or in connection with the entertainment of persons in the refreshment house during the hours of late opening, whether for the supply of food or drink, for admission, for service of any description or for any other matter, except any reasonable charge of the use of cloakroom or toilet facilities, unless: (a) a tariff or charges made in the refreshment house is, during those hours, kept displayed in such positions and in such manner that it can be conveniently read by person frequenting the refreshment house and can be so read by any such person before entering; and (b) the charge is specified for the matter in question in the tariff or is less than a charge so specified. It shall not be lawful to seek to obtain custom for the refreshment house by means of personal solicitation outside or in the vicinity of the refreshment house. A condition may be imposed on the grant or renewal of a licence prohibiting the opening or keeping open of the refreshment house for public refreshment, resort or entertainment at any time between 11.00 p.m. and 5.00 a.m., the following morning. Any infringement of any of the conditions imposed, render the offender liable to a fine of £200 or three months imprisonment, or both, and the Court may on conviction disqualify persons from holding a licence. The holder of a licence in respect of a refreshment house, on any change of address which affects the list or register of licences kept by the licensing authority, shall notify the authority in writing of the new address to be entered in the list or register as his place of abode; and if he fails to do so within two weeks after the change of address, he shall be guilty of an offence and liable on summary conviction to a fine not exceeding twenty pounds. Forty-three refreshment house licences were issued by this department during the year. 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. The Food Hygiene (General) Regulations, I960, and the Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966 are the principal instruments for enforcing good food hygiene practice, 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, 87 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 & 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 509 47* (b) for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale 174 26 2. Milk & Dairies (General) Regulations, 1959 as dairies or where the occupier is registered for the sale of milk in sealed containers only 260 16* * 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 Regulations 16 and 19 of the Food Hygiene (General) Regulations, 1960:- 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 Butchers Bread and Cake shops Greengrocers Confectioners Cafes, restaurants, Public Houses and off-licences Fishmongers and fried fish shops General provision shops Street markets Stalls Storage premises 23 120 62 107 211 737 45 267 103 55 9 21 14 12 9 560 16 118 375 2 23 120 62 107 211 724 45 264 *14 +21 23 120 62 106 211 736 45 267 12 37 * 89 use nearby public conveniences +34 have sharing arrangements 88 Unsound Food Food Sampling The practice continued during the year of taking formal samples only in those cases where there was reason to believe a product was well below the required standards, usually following an adverse report on an informal sample. 1,110 informal samples were submitted for analysis, of which 69 were either adulterated or otherwise unsatisfactory. Ten formal samples were also submitted for analysis, of which six were either adulterated or otherwise unsatisfactory. In the case of one of the formal samples, legal proceedings were authorised, details of which are given at the end of this section of the Report. The remaining five formal samples were dealt with satisfactorily on an informal basis. The results of all unsatisfactory samples were brought to the notice of the producers, manufacturers or vendors as appropriate. Complaints During the year, 141 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, fruit, bread, sweets, cakes, milk, cheese, wine, vegetables, yoghurt, fish, soft drinks, poultry, eggs, jam and soup. Of these complaints, sixteen cases resulted in the Health Committee instructing that legal proceedings be instituted. The remaining one hundred and twenty-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) 637 Meat (Other) 12 Ham and Pork 674 Sauerkraut 168 Cucumbers and Gherkins in brine 134 Butter and Cheese 375 Fish (wet and dry) 84 Sausage 2,214 TOTAL 4,298 Tins, jars, packets or cartons of fruit, vegetables and miscellaneous foodstuffs Frozen foods (packets) Items 6,548 19,764 TOTAL 26,312 89 All food condemned as unfit for human consumption is collected by the Council, taken to the refuse destructor in Fulham, and destroyed. 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 1969 Total number in force at end of year Untreated milk - 105 Pasteurised milk 5 255 Sterilised milk 5 210 Ultra-heat Treated milk 6 166 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 results obtained: Designation No. of Samples Methylene blue Test Phosphatase Test Colony Count Test Turbidity Test P F P F P F P F Untreated - - - - - - - - - Pasteurised *33 19 1 33 — — — — — Sterilised 1 - - - - — — 1 — Ultra-heat Treated 9 - - - - 9 - - - P=Passed F=Failed * Of these 33 samples of pasteurised milk, 13 were rendered void because the atmospheric shade temperature exceeded 70 degrees Fahrenheit and the Methylene blue tests could not be carried out. Milk & Dairies (General) Regulations, 1959 Registrations The number of person 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 260. 90 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 term "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. Five complaints were investigated during the year. Successful legal proceedings were taken in one case concerning a churn of milk which contained insect larvae. Two cases were referred to the local authority in whose area the bottling plant was located and the remaining cases were dealt with by informal approach to the producers at the request of the complainants. Composition of Milk During the year, 122 samples of milk (all grades) were submitted to the Public Analyst for examination. All were found 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 four per cent by weight of milk fat. This compares with the presumptive milk fat standard of three per cent 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 8 4.35 8.79 February 3 4.28 8.63 March 5 4.28 8.75 April 3 4.28 8.86 May 3 4.33 9.01 June 4 4.16 8.90 July 5 4.24 8.87 August 3 4.23 8.88 September 3 4.36 8.96 October 2 4.42 8.92 November - — — December - - - Average for the whole year 4.29 8.83 Legal minimum standard 4.00 8.50 91 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 6 3.77 8.56 February 5 3.63 8.56 March 6 3.61 8.54 April 4 3.41 8.47 May 9 3.43 8.6l June 5 3.4l 8.72 July 9 3.48 8.67 August 5 3.57 8.53 September 7 3.69 8.65 October 11 3.79 8.66 November 11 3.73 8.73 December 5 3.98 8.73 Average for the whole year 3.62 8.62 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") 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 stablising 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 1969 for chemical analysis compared with those taken in the previous year:- Number of samples 1968 1969 17 12 Variation of fat content per cent 5.3 to 11.2 6.0 to 11.9 Variation of non-fat content per cent 21.O to 28.3 20.6 to 27.2 Average fat content per cent 8.3 9.24 Average non-fat content per cent 25.5 24.76 92 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, thirty-two samples of ice-cream were taken and submitted to the methylene blue test. The results were as follows:- Grade Number of samples 1 6 2 5 3 7 4 14 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 twenty-four 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. 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. LICENSING AND REGISTRATIONS Certain licensing and registration duties, formerly carried out by inspectors in the Town Clerk's department, where the work involved both inspection and investigation in addition to administrative and clerical duties, were transferred to this department on 2nd September 1968. The details of these duties and the enactments under which they are carried out are as follows:- Licensing and inspection of employment agencies (London County Council (General Powers) Act, 1921, Byelaws (25) approved by the Secretary of State, and conditions (5) attached to the licences). 93 Licensing and inspection of nurses agencies (Nurses Agencies Act, 1957 and regulations made thereunder). Licensing and inspection of massage establishments (London County Council (General Powers) Act, 1920, byelaws (8) approved by the Secretary of State, and conditions (9) attached to the licences). Registration of premises for the sale and storage of explosives (Explosives Act, 1875 and Keeping of Fireworks Order, 1959). Registration of premises for the storage of celluloid and cinematograph film) (Celluloid and Cinematograph Film Act, 1922). All the above-mentioned licences and registrations are renewed annually. Permits for the provision of amusements with prizes (Betting, Gaming and Lotteries Acts 1963/4) Permits are renewable every three years. Registration of theatrical employers (Theatrical Employers Registration Acts, 1925 and 1928). Administration of the Shops Acts. 1950/1965 Administration of the Young Persons (Employment) Act, 1938 Officers Transferred The officers transferred from the Town Clerk's department consisted of: one Senior General Purposes Inspector and two General Purposes Inspectors in addition to a qualified Physiotherapist employed by the Council in connection with the licensing of massage establishments. (This Officer is engaged on a sessional basis amounting to a maximum of three hours per week for approximately 40 weeks during the period of a year). DUTIES INVOLVED Employment Agency Licences & Nurses Agency Licences All applicants for these licences (and directors of companies applying for licences) are interviewed by an inspector, the personal history of each person is checked in respect of the previous ten years, and each application is the subject of a report either to the Committee or to the Medical Officer of Health. The investigations often include enquiries of the Criminal Records Office, County Court Judgments Register, other local authorities, and also involve liaison with other departments of the Council, e.g. Town Planning Section. Each licence so granted is delivered personally by an inspector and copies of the byelaws governing the conduct of employment agencies handed to the licensees. At this visit, the inspector advises on methods of compliance with these byelaws. Subsequently, routine inspections are carried out to ensure that these are complied with, and complaints are investigated from time to time. 94 All licences expire on 31st, December, of each year and are renewed annually. Massage Establishments Licences In these cases also, the applicants are visited by an inspector of the Council and their individual qualifications are checked. The procedure then follows that in respect of employment agencies. In April, 1967 new conditions were attached to all licences granted in this borough which are unique at this present time to this borough. These conditions have had the effect of encouraging certain licensees to move their establishments to other areas. It has been appreciated that the licensing conditions as they exist at the moment are in some respects inadequate, and this Council has been one of the prime movers in representation being made to the London Boroughs Association for a revision of same. All licences expire on 31st March of each year and are renewed annually, Premises for the Sale and Storage of Explosives During 1969, a total of 93 premises in the borough were registered for the storage and sale of fireworks. All the premises were inspected to ensure that the methods of storage and display of the fireworks were in accordance with the provision of the Acts. A total of 30 infringements of the Regulations were detected, and in these cases the occupiers of the shops concerned were warned that a serious view was taken of any contravention of the Regulations. On subsequent inspections being made, it was found that compliance with the Regulations had been obtained, Permits for the Provision of Amusements with Prizes Each application involves a visit to the premises by an inspector whose report is submitted to the Chairman for approval, Originally in 1965, each applicant was requested to attend the General Purposes and Civil Defence Committee, and the report form was subsequently designed to provide the answers to the type of questions put forward by that Committee. By virtue of the provisions of the Gaming Act, 1968, on 1st July 1970, the granting of permits in certain cases will pass to the Licensing Justices in this area. Close liaison has been maintained with the clerk to the Justices and arrangements have been completed for the easy transfer of the relevant records and documents prior to that date. Administration of the Shops Acts & Young Persons (Employment) Act Inspection duties in this sphere during 1969 were limited to dealing with complaints and enquires received and were largely of an advisory nature. The complaints, however, were mainly in connection with illegal trading after the closing hours prescribed by the Shops Act, 1950 and finally resulted in the taking of legal proceedings in a number of cases. 95 STATISTICS The following is a summary of the number of licences, permits, etc., issued during the year ended 31st December, 1969:- Licences. Permits, etc. New licences etc., granted during year Total in force at 31.12.69 Employment Agencies 60 178 Nurses Agencies 2 6 Massage Establishments 10 111 Theatrical Employers 5 203 Permits for the Provision of Amusements with Prizes 33 210 Storage and Sale of Fireworks 7 93 Storage of Celluloid and Cinematograph Film - 1 GENERAL COMMENT These functions may be described as measures dealing with the safety and general well being of the community, as well as the prevention of both exploitation of the public and of the setting up of injurious or immoral practices within this borough. The regulations are mainly pre-war, and undoubtedly need revision. Nevertheless, the principles involved have become more important in many cases because of the expansion both in number and character of the organisation which come within the purview of these Acts. This borough, because of its central position, is one of the three inner London Boroughs mainly concerned with this work and a close liaison has been maintained with both the Westminster City Council and the London Borough of Campden to ensure, as far as possible, uniformity of administration. HOUSING In my Annual Report for last year, special reference was made to the problems associated with improvement and modernisation of older houses, and to the legislation which existed, and was proposed at that time, to enable local authorities to extend the useful life of such properties. Progress with this important work was continued during the year and on the 25th August 1969 a new Housing Act came into force which amended and extended the Council's powers for dealing with these problems: These changes include: (a) Amendments to the regulations relating to the familiar improvement (discretionary) grants and standard grants, including an increase in the amounts of grant, which can be obtained, together with the introduction of a new special grant for improving conditions in multioccupied houses; 96 (b) The introduction of new powers for changing controlled tenancies to regulated tenancies where they have been brought up to a satisfactory standard, with a resultant increase in the rents of such tenancies phased over a period of time; and (c) The replacement of existing powers which enable local authorities to declare General Improvement areas. All the above matters are dealt with more fully later in the report, which follows. Slum Clearance Action already taken The following table gives details of the clearance areas declared in the borough since 1950: 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) 11.12.1956 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 17.10.1961 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 Lancaster Road (West) (No. 4) 29.10.1968 57 415 Lancaster Road (West) (No. 5) 29.10.1968 5 17 Kensal Mew Town Area This area, consisting of over twenty acres, lies in the north eastern part of the borough. Clearance and redevelopment of 8.1 acres has been completed and in a further 3.1 acres, l6l flats were provided during 1969, It is anticipated that a further 28 flats and 157 hard standings for cars will be provided on this site in 1970. 97 The remaining residential portion, consisting of 7.2 acres and bounded by Golborne Road, Kensal Road and railway, is being redeveloped by the Greater London Council. Work continued during the year to provide 281 flats on this site. Adjoining this area to the north, the Greater London Council are to provide an open space of approximately 3.5 acres, part of which is 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 originally contained approximately 455 houses, 15 factories, 140 shops, 6 licensed premises and 11 other business premises in an area of 27 acres. The whole area is being dealt with in four stages, and during 1969, following a Public Inquiry, a Compulsory Purchase Order was confirmed by the Minister of Housing and Local Government in respect of the final stage. The Council are now acquiring all the properties in the area and by the end of the year 488 families had been rehoused. Demolition of the properties in the first stage of the area commenced during the year and it is anticipated that approximately 7 acres will have been cleared of buildings by the end of 1970. Linked with this Lancaster Road (West) redevelopment area is the Blechynden Street Area, situated north-west of the metropolitan railway line. This area is being redeveloped by the Greater London Council and by the end of the year, 114 flats had been completed of the total of 342 flats which are to be provided on this twelve-acre site. GENERAL IMPROVEMENT AREA Section 28 of Housing Act, 1969 defines a General Improvement Area as one where the living conditions ought to be improved by the improvement of the amenities of the area or of dwellings therein or both and that such an improvement may be effected or assisted by the exercise of the Local Authority's powers under this Act. The area bounded by Talbot Road on the north, Ledbury Road on the east, all properties in Lonsdale Road (other than the Portobello Court Estate) on the south and Portobello Road on the west was declared a General Improvement Area by the Council on 28th October, 1969. The area contains 302 properties of which 265 are used for habitation. There is in addition a school building and two modern blocks which are owned by the Council and which contain 20 self-contained flats. The 302 properties can be divided into three main types. First the properties in Portobello Road, Talbot Road and part of Ledbury Road which have a business use on the ground floor and the upper part occupied for living purposes or suitable for such occupation. Secondly, the large, substantial and valuable properties consisting of basement and four or five storeys such as are found in Colville Square, Colville Gardens, Powis Square and Colville Terrace. Thirdly, the three-storied and basement terraced properties in Lonsdale Road which are not so substantial as the previous type but still seem to be worth preserving. All the properties in the area are being surveyed and every endeavour is being made to persuade owners to improve their properties, if possible by converting them into self-contained flats with the aid of the increased grants which are payable under the Housing Act, 1969. 98 Approved expenditure by the Council in respect of works of environmental improvement in the area attract a new specific grant under the Act and the Borough Planning Officer in giving consideration to this matter. Grants for the Improvement or Conversion of Private Dwellings The circumstances in which the Council may make discretionary and standard grants to owners for the improvement or conversion of private dwellings, as detailed in my Annual Report for 1965, were revised in August by the introducton of the Housing Act, 1969. The principal changes made the new Act, together with details of the number of applications dealt with in respect of the two main types of grant, are given below: Improvement (Discretionary) grants The following is a summary of the number of discretionary grants approved during 1969, together with a graph showing comparative figures since 1965. when the present borough was first formed:- Applications granted 246 Applications refused Nil Total amount of grants approved £76,651 Under Part I of the Housing Act, 1969 and among other things, the maximum amount of grant payable to owners has been raised from £400 to £1,000 per dwelling (from £500 to £1,200 in respect of a dwelling formed in a building of three or more storeys); the conditions previously imposed on applicants to observe certain requirements concerning rent limits and the sale of the property have been removed; and for the first time, certain works of repair and replacement which are incidental to the works of improvement or are necessary to give full effect to the improvements have been made eligible for grant aid. 99 In view of the unavoidable time which must elapse between the receipt of an application and its approval, the statistics given above take no account of the very considerable increase in grants which is expected in 1970 as a result of the new provisions and which was indicated by the number of enquiries and applications being received by the end of the year. Standard Grants The main amendments made by the Housing Act, 1969 to the provision regarding standard grants were the removal from the list of basic amenities of the requirement relating to a ventilated food cupboard and the inclusion of a sink, and the raising of the maximum amount of grant payable in respect of each amenity so that where all seven of the new amenities are being provided for the first time the total amount of grant has been increased from £155 to a maximum of £200. The conditions concerning rent limits and sale of the property have also been removed. Four applications for standard grants were received during the year in respect of individual premises, All four applications were approved. Qualification Certificates Part III of the Housing Act, 1969, introduced new powers governing rents of controlled tenancies whereby landlords can apply to the Rent Officer to have a tenancy changed to a regulated tenancy where the dwelling has been certified by the local authority to meet certain qualifying conditions. On receipt of an application from the landlord of a controlled tenancy, the Council may issue a Qualification Certificate if they are satisfied that the dwelling was provided, before the 25th August 1969, with all the standard amenities for the exclusive use of the occupier, is in good repair having regard its age, character and locality, and is in all other respects fit for human habitation. If at the time of application the dwelling does not possess all the standard amenities, the applicant must submit to the Council details of the works proposed by him to provide those which are lacking. Certificate of Provisional Approval may then be issued to the landlord and submitted by him to the Rent Officer who will then issue a Certificate of Fair Rent. The Council may only issue a full Qualification Certificate on completion of the proposed works and production of the Certificate of Fair Rent. When a Qualification Certificate has been obtained by the landlord, he may submit it to the Rent Officer and have a fair rent registered in respect of the new regulated tenancy. Any resultant increase in rent is phased over a number of years. The following shows the number of applications for qualification certificates dealt with in the latter part of the year:- Applications received Certificates Issued Refused Certificates of Provisional Approval 4 Nil 2 Qualification Certificates 82 5 5 Seventy-four of the above applications were still being dealt with by the end of the year. House Purchase Loans During the year, thirty-four properties were inspected as the result of applications to the Council for house purchase loans. 100 Certificates of Disrepair in relation to Dwelling Houses The Council's duty to issue certificates of disrepair in respect of "rent controlled" dwelling hourse, not reasonably suitable for occupation, is governed by the Rent Acts. It was not found necessary to taken any action regarding certificates of disrepair during 1969. Overcrowding All cases of overcrowding are dealt with on the strict interpretation of the standard laid down in the Housing Act, 1957, distinguishing between "penal" and "non-penal". The number of new cases of overcrowding reported to the Housing Comittee during 1969 was 6l (28 penal and 33 non-penal), giving an equivalent number of persons of 234, The total number of recorded cases where overcrowding was abated during the year was 53, comprising a total of 223½ units. Since October, 1945, 2,808 cases have been reported, and the number of cases remaining on the register at the end of this year was 295 (32 penal and 263 non-penal). NOTE: Units mean the number of equivalent persons in the families, obtained by regarding children between one and ten years of age as "half persons" and disregarding infants under the age of twelve months.) Individual Unfit House and Parts of Houses Houses made fit after informal action under the Housing or Public Health Acts 377 House repaired after service of formal notices under the Public Health Acts 334 Houses made fit after service of formal notices under Section 9 of the Housing Act, 1957 (a) by owners 88 (b) by local authority in default 11 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 Nil (d) undertaking accepted from owners to render houses fit for habitation Nil (e) houses rendered fit for habitation by owners and closing orders determined Nil Action under Section 18 of the Housing Act, 1957 (a) closing orders made 14(25 rooms) (b) closing order determined 23(50 rooms) (c) closing orders cancelled (premises demolished) 1(2 rooms) (d) consent given to use of closed rooms for non-sleeping purposes 3(3 rooms) (e) undertakings accepted from owners to render part of building fit for habitation 6(7 rooms) (f) part of building rendered fit and undertaking cancelled 4(6 rooms) 101 Assessment of Housing Priorities on Medical Grounds During the year, 231 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 164 cases. STRIKE OF REFUSE COLLECTORS During October, 1969 there was a strike of dustmen which lasted for approximately three weeks. After the first few days of the strike the Council decided to issue plastic bags from various centres to the residents and it was felt that some assistance could be given in this task by arranging for the distribution of the bags and explanatory leaflets from the premises under the control of the Health Committee. It was therefore arranged for such distribution to be undertaken from all Health Centres, Day Nurseries and Home Help Offices. Complaints then started to arise from residents in respect of smells and flies from the increasing amount of rubbish in the borough. Arrangements were made for the Council's disinfecting staff to spray all rubbish heaps where such complaints were made. The number of complaints frequently required work to be undertaken outside the normal hours of work. The number of rubbish heaps throughout the borough increased to such an extent that some of the rodent officers were diverted from their normal duties to assist in this work. Considerable worry was caused by the accumulation of rubbish in the street markets of Portobello Road and Golborne Road. In spite of frequent spraying of all rubbish, it was thought at the time that trading in the food markets would have to be prohibited, Fortunately this was not necessary as the Council decided to employ private contractors to remove some of the rubbish in the borough and the Borough Engineer made a priority task of the removal of the rubbish in the street markets. No facilities were available to take the rubbish to the barges at the Council's wharf and it was therefore taken by a fleet of lorries to Wood Lane Depot. The rubbish was then loaded by crane into larger lorries for transport to controlled tips on the outskirts of London. Initially the open land at Treadgold Street was also used for this purpose but it was felt that it was unwise to continue the use of this site and by arrangement with the Borough Engineer its use was immediately discontinued. The quantity of rubbish at Wood Lane Depot become too great for the Disinfection Staff to spray and an arrangement was made for the necessary spraying to be undertaken by a commercial firm. Subsequently a motorised spray was hired and routine spraying of the rubbish dump and surrounding area was undertaken each day by the staff of the Health Department. 102 Throughout the emergency, the Public Health Inspectors were in close touch with the officers of the Borough Engineer's Department and every assistance was given in determining the priorities for removal of rubbish which were causing a health nuisance. Co-operation between the two departments was in evidence at all times and it was felt that all necessary step's were taken by the officers concerned to protect the health of the residents of the Borough. LEGAL PROCEEDINGS Public Health Act, 1936/1961 Nuisances During the year, fifty-six summonses were issued for various nuisances under the Public Health Act, 1936/1961. In seventeen cases, Abatement Orders were secured, fines totalling £68 0s 0d and costs amounting to £31 2s Od. In twenty-four cases, the summonses were withdrawn, the nuisances having been abated prior to the Court hearings, and in nine cases the summonses were adjourned sine die as the necessary works were being carried out by the defendants. In these cases, the summonses were not served, in the one case the summons was withdrawn and in two cases the summonses were re-served. Byelaws as to the Artificial Lighting of Common Staircases in Tenemant Houses and Flats Two summonses were issued against a landlord for a contravention of the above Byelaws in respect of failure to provide adequate means for the artificial lighting of the common staircase in two tenement houses. Convictions were obtained and fines amounting to £20 0s 0d were imposed and the Council were awared £4 0s 0d costs. Clean Air Act, 1956 Three summonses were issued against a Stores, an Airways Terminal and a Supermarket who permitted smoke to be emitted from chimney of buildings contained in the Kensington No. 8, Earls Court/Queensgate 1966 and Kensington No. 11 Brompton/Queensgate 1967 Smoke Control Orders. The Magistrates imposed fines totalling £20 0s 0d and the Council were awarded costs amounting to £9 0s 0d. Offices, Shops and Railway Premises Acts, 1963 Eight summonses were taken out against three defendants for contraventions of the above Act. The contraventions included the failure to supply a thermometer to enable the temperature to be determined; failure to provide a substantial handrail to the staircase; failure to properly maintain the stairs (defective stair treads and nosings); failure to properly maintain the floor covering and floor boards; failure to provide suitable and sufficient washing facilities, and failure to maintain and keep clean the sanitary convenience. In these cases, the summonses were withdrawn as the work had been carried out prior to the Court hearings. The remaining five summonses were in respect of one defendant who was found guilty but was given an absolute discharge by the Court, as the majority of the work had been carried out by the day of the hearing. - 103 - Housing Act, 1957 Overcrowding Six summonses were issued for permitting dwelling houses to be overcrowded. In three cases, convictions were obtained and fines totalling £45 0s Od were imposed and costs amounting to £6 0s Od were awarded to the Council. In one case the summons was not served and in two cases the summonses were withdrawn as the overcrowding had been abated. Food and Drugs Act. 1955 The Perservatives in Food Regulations. 1962 One summons was issued in respect of the sale of Salad Dressing which contained added perservative (Benzoic Acid) not permitted by the Regulations, A conviction was obtained and a fine of £10 0s Od was imposed, the Council being awarded £10 0s Od costs. Section 2 - Offences Sixteen summonses were issued in respect of the sale of food not of the nature, substance as quality demanded. In fourteen cases, convictions were obtained and fines totalling £165 0s Od were imposed, and the Council were awarded £91 8s Od costs. One case was withdrawn on the advice of the Borough Solicitor and the remaining case was acquitted. Public Health Act, 1891 - G.L.C. Water Closet Byelaws One summons was issued for failing to provide ventilation for male accommodation. The case was withdrawn as the necessary work was carried out by the defendant. Public Health Act. 1936 - Section 34(1) One summons was issued against a builder concerning drainage works contravening the G.L.C. Drainage Byelaws. A conviction was obtained, a fine amounting to £2 0s Od was imposed and the Council were awarded £2 0s Od costs. Shops Act, 1950 Six summonses were issued for trading non-exempted articles after general closing hour. Convictions were obtained, fines totalling £17 0s Od were imposed and the Council were awarded £12 0s Od costs Greater London Council (General Powers) Act, 1968 Four summonses were issued for using premises as night cafes when not registered with the Council, after 2nd June 1969. Convictions were obtained, fines totalling £115 0s 0d were imposed, and costs amounting to £8 0s 0d were awarded to the Council. - 104 - Offence Regulations Result Fine Costs awarded to Council £ s. d. £ s. d. CASE NO.1 Failed to provide wash-hand basins for the use of persons engaged in handling food 16(1) 5 0 0 2 0 0 CASE NO. 2 Failed to keep in good order, repair and condition the ground floor food shop to enable it to be effectively cleaned 23(1) 5 0 0 2 0 0 Placed food, namely items of greengrocery lower than 18" from the ground risking contamination 8(b) 5 0 0 - - - CASE NO. 3 Placed food, namely items of greengrocery lower than 18" from the ground risking contamination 8(b) 5 0 0 - - - CASE NO. 4 (RE-SERVED)* Failed to keep free from contamination, a food mixer 6 10 0 0 10 0 0 Food stored on kitchen roof was so placed to involve risk of contamination 8(a) 10 0 0 - - - Failed to keep in good order, repair and condition skylight in kitchen 23(1) 5 0 0 - - - Risked contamination of food in kitchen due to construction of extract fan duct and skylight 5 5 0 0 - - - Failed to keep clean the walls of the kitchen 23(1) 10 0 0 - - - Failed to keep clean the floor of the kitchen 23(1) 10 0 0 - - - Failed to keep clean the equipment, i.e. cooking stoves, grills, refrigerators, cooking utensils and storage shelving 6(1) 10 0 0 - - - Failed to keep in good order, repair and condition for effective cleaning, the woodwork surrounds to sinks in kitchen 23(1) 10 0 0 - - - Failed to provide wash-hand basins for the use of persons handling food 16(1) 20 0 0 - - - The dining room communicated directly with a place which contains a sanitary convenience 14(4) 10 0 0 - - - - 105 - Offence Regulations Result Fine Costs awarded to Council £ s. d. £ s. d. CASE NO. 5 Failed to keep clean the equipment i.e. gas cookers, cooking utensils and food preparation table in the kitchen 13 10 0 0 10 0 0 Failed to keep clean the walls in the kitchen 23(1) Absolute Discharge Failed to keep clean the floor in the kitchen 23(1) Absolute Discharge Failed to keep clean the floor of the basement passageway 23(1) Absolute Discharge Failed to keep in good order, condition and repair as to enable effective cleaning, the food hoist in the basement passageway- 23(1) Absolute Discharge Failed to keep in good order, condition and repair as to enable effective cleaning, the floor covering in the basement passageway- 23(1) Absolute Discharge Failed to keep in good order, condition and repair as to prevent risk of infestation by vermin, the sash window in the front storeroom 23(1) Absolute Discharge Failed to keep clean the room containing the sanitary convenience 14(2) 10 0 0 - - - Failed to keep in efficient order the flushing apparatus of the sanitary convenience 14(1) 10 0 0 - - - Failed to affix in a prominent position a notice requesting users of the convenience to wash their hands 14(5) 10 0 0 - - - Failed to provide in a readily accessible position suitable first aid equipment 17 10 0 0 - - - Failed to provide wash-hand basins for the use of persons engaged in the handling of food 16(1) 10 0 0 - - - Failed to keep clean the sink provided in the saving area for washing food and equipment 19(1) 10 0 0 - - - Failed to provide sufficient cupboard and locker accommodation for clothing and footwear not worn during working hours by persons engaged in the handling of food 18 10 0 0 - - - Food stored in a cardboard box in kitchen was so placed as to risk contamination 8(a) 10 0 0 - - - Food stored on the food preparation table in kitchen was so placed as to risk contamination 8(a) 10 0 0 — — - - 106 - Offence Regulations Result Fine Costs awarded to Council £ s. d. £ s. d. CASE NO. 6 Failed to provide and maintain suitable and sufficient washhand basins for the use of persons engaged in the handling of food 16(1) 5 0 0 2 0 0 CASE NO. 7 Failed to keep clean the equipment i.e. gas cooker, gas griller in the basement kitchen 6(1) 20 0 0 2 0 0 Failed to keep clean the walls of the basement kitchen 23(1) 20 0 0 - - _ Failed to keep clean the floor of the basement kitchen 23(1) Proved but no separate penalty Failed to provide wash-hand basin for the use of persons engaged in the handling of food 16(1) 20 0 0 - - - Failed to protect food from risk of contamination i.e. left uncovered the waste food bins 8 20 0 0 - - - Failed to seal the waste group connectors of the sink in the kitchen 12(2) 10 0 0 - - - Failed to provide suitable and sufficient ventilation to the room containing the male sanitary convenience in the basement 14(2) 10 0 0 - - - Used for the handling of open food, the basement dining room which communicated directly with a room containing a sanitary convenience 14(4) 10 0 0 - - - * In case No. 4, the first summons was wrongly served and costs amounting to £5 0s Od were awarded against the Council. The summons was subsequently re-served on the new owner. Section 7 WELFARE SERVICES - 107 - 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. - 108 - FORWARD PLANNING Residential Homes Former Public Assistance Institution - King's Mead Reference was made in last year's report to the Council's Welfare Committee's decision to commence the running-down programme at King's Mead when the new purpose built home 'Dovehouse Court', was opened. The first residents were admitted to this home on 8th September, 1969, and subject to satisfactory staff being available 92 residents will be transferred by the end of March 1970. During the year loan sanction was granted for a home of 6l beds to be built at Edenham Street, Kensal New Town and building work commenced on 1st July, 1969. This home should be ready for occupation in approximately two years. The final replacement home is at present being designed by the Council's Architect and will be sited within the grounds at King's Mead. It is hoped that loan sanction will be granted early in the new year. This would permit building work to start during July 1970 and the home to be ready for occupation during July 1972. It is understood that the London Borough of Hammersmith who at present occupy beds at King's Mead in accordance with a sharing agreement will open a new home during the early months of 1972. Subject, therefore, to all the above conditions being met the former Public Assistance Institution should be closed by July 1972. Temporary Accommodation The Greater London Council have confirmed that the premises 144-l48, Earls Court Road at present used by the Welfare Committee to provide 18 units of temporary accommodation will be required for the widening and redevelopment of the West Cromwell Road by the end of 1970. Negotiations are at present in hand to acquire a building for conversion to seven units of accommodation, in addition plans have been prepared to extend the number of units at Trenmar Lodge. RESIDENTIAL ACCOMMODATION The number of persons in residential accommodation at 31st December, 1969, was as follows:- Council accommodation 496 Other local authority homes 14 Voluntary homes 206 Total 716 The Council maintain five residential homes for aged and infirm persons under Section 21(l)(a) of the National Assistance Act, 1948. Two of the homes are outside the Borough boundary. The total number of beds is allocated as follows Dale Mead 55 men and women Dovehouse Court 35 ,, ,, ,, Ellesmere 116 ,, ,, ,, King's Mead 282 ,, ,, ,, 5, Holland Park 31 women Total 519 - 109 - There were 264 new admissions and 142 discharges from the Council's homes during 1969. In the same period, 119 persons died in the homes. Vacancies are held for short-term admissions to hospitals, residents who are away on holiday, and for major redecoration programmes. The total number of re-admissions from hospital was 98 and discharges to hospital amounted to 140. Age Analysis at 31st December 1969. (Where figures are shown in brackets they relate to the previous year and are included for comparison.) Home Total Dale Mead Dovehouse Court Ellesmere No. 5 Holland Park King's Mead Under 30 years Male - - - - - - Female - - - - - - 30-49 years Male — — - - — - Female - - - - 2 2 50-64 years Male _ 2 3 — 4 9 Female - 1 - 3 6 10 65 - 74 years Male 3 3 6 — 29 41 Female 4 9 17 7 34 71 75-84 years Male 8 6 15 - 31 60 Female 22 6 41 10 86 165 85 years and over Male 2 1 7 - 7 17 Female 14 6 22 10 69 121 TOTALS: Male 13 12 31 - 71 127 Female 40 22 80 30 197 369 Average Age 81.5 67.9 79.2 79.6 78.6 77.3 (Average Age 31.12.68) (80.6) - (79.8) (80) (78.4) (79.7) - 110 - Admissions and Discharges The following statistics show the admission and discharges at each residential home for the period, 1st January to 31st December 1969: HOME _ Dale Mead Dovehouse Court Ellesmere No. 5 Holland Park King's Mead TOTAL Resident on 1.1.68 Men 13 - 29 — 70 112 Women 40 - 78 29 228 375 Total 53 - 107 29 298 487 (488) Admissions (new) Men 2 13 14 - 64 93 Women 7 22 37 10 154 230 Total 9 35 51 10 218 323 (283) Discharges (perm.) Men - - 4 - 58 62 Women 4 - 24 4 93 125 Total 4 - 28 4 151 187 (158) Died Men 2 - 7 - 8 17 Women 2 - 8 3 89 102 Total 4 - 15 3 97 119 (128) Remaining on 31.12.69 Men 13 12 31 - 70 126 Women 40 22 80 30 198 370 Total 53 34 111 30 268 496 (485) Normal accommodation 55 35 116 31 282 519 (519) (Figures for previous year shown in parentheses) - Ill - 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 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 in the following table:- Name of Home Owning Borough Resident on 1.1.69 Admitted Discharged Remaining on 31.12.69 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 2 - - - - 1 1 1 - 1 Southern Grove Lodge Tower Hamlets - 1 1 - - - - 1 1 - - - Ladywell Lodge Lewisham - 4 4 - - - - 4 4 - - - Brocklebank Wandsworth - 3 3 - - - - 1 1 - 2 2 Ashmead Wandsworth - 1 1 - 1 1 - - - - 2 2 White Chester Hammersmith 1 — 1 — - — - — — 1 - 1 Whitby Dene Hillingdon 1 - 1 - - - - - - 1 - 1 Moorcroft Hillingdon 1 - 1 - - - 1 - 1 — - - Kenwold Westminster 1 — 1 - — - — - — 1 - 1 The Leys Barnet 1 — 1 — — - — - - 1 - 1 Thomas Taylor Homes Northumberland 1 - 1 — — - - - - 1 - 1 The Gables Hampshire 1 - 1 1 — 1 — — — 2 - 2 Shirley Croydon 1 - 1 1 - 1 - - - 2 - 2 TOTAL 11 10 21 2 1 3 1 7 8 12 4 16 - 112 - Accommodation provided by Voluntary Organisations On 31st December, 1969, there were 207 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 2 13 Deaf 1 3 Epileptic 3 - Physically handicapped 18 21 Others 7 139 Total 31 (27) 176 (166) By age and sex Male Female Under 30 years 2 1 30 - 49 years 1 3 50-64 years 8 15 65 — 74 years 13 34 75 - 84 years 16 61 85 years and over 2 51 Total 42 (38) 165 (155) Seventy-eight homes were used for this purpose. Waiting List for Admission to Homes for Aged Persons There were 90 persons on the waiting list for admission to residential accommodation at 31st December, 1969, viz:- Urgent Applications for Admission Normal Applications for Admission Total Men 14 12 26 Women 39 25 64 TOTAL 53 37 90 Names were added to the waiting list at the rate of 25 persons per month. In cases of genuine emergency 48 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 twelve months. - 113 - TEMPORARY ACCOMMODATION Homeless Families. The Council has a responsibility under Section 21(l)(b) of the National Assistance Act, 1948, to provide temporary accommodation for persons in urgent need through circumstances which could not reasonably have been foreseen. Emergency provision is also made for victims of fire and flood whilst they are temporarily homeless. The premises, in use for homeless families are as follows:- 144/148, Earls Court Road, S.W.5. 16 family units available for use up to April 1971. 68, Holland Road, W.l4. 7 family units 16/18, Wrights Lane, W.8. 16 family units 68, Oxford Gardens, W.10. 3 family units 228, Lancaster Road, W.ll. 5 family units 84/90, Princedale Road, W.ll. 11 family units 32, Dawson Place, W.2. 7 family units 201, Ladbroke Grove, W.10. 5 family units 210, Ladbroke Grove, W.10, 5 family units Trenmar Lodge, Trenmar Gardens, N.W.10. 5 family units Families admitted received social work support and intensive casework guidance where necessary. This approach is proving to be constructively helpful in rehabilitating and preparing families for eventual rehousing, and also helps to keep to a minimum the number of otherwise long stay cases which could create a heavy demand for additional units of accommodation. The following statistics show the number of families received into and discharged from temporary accommodation during the year:- Number of families in temporary accommodation as at 1.4.69 63 Number of families admitted (comprising 64 men, 125 women and 324 children) 124 Number of families discharged 117 Number of families remaining as at 31-12.69 70 The reason for homelessness were as follows:- Rent arrears 12 Unauthorised occupants 25 Overcrowding 12 Family disputes 12 Landlord wanted accommodation 2 New to London 6 Objection to children 4 Fire Victims 8 From hotel accommodation 8 Service contract ended 4 Landlord disputes 6 Essential repairs 7 Sale of property 8 Other reasons (including default on mortgages, expiry of lease) 10 - 114 - Of the 117 discharges, 21 were rehoused by nomination for housing allocated to this Council by the Greater London Council, 25 were rehoused by the Council, 46 were assisted to find accommodation, and 25 found their own accommodation. The casework approach of the family caseworkers is based principally on three main conditions (a) Acceptance by the family of their financial responsibility, regular payment of charges, proper budgeting,, and the payment of any outstanding debts including rent arrears, (b) Ensuring that the family can maintain themselves in close living conditions by training the parents into good standards of child care, i.e., correct feeding, adequate clothing and reasonable discipline; appreciation of the value of regular school attendance, and a constant care of the health and well-being of the family. (c) Acceptance by the husband of the need to secure and maintain himself in full time employment. Encouragement and assistance ares given in all the foregoing when necessary. The response shown by families was encouraging and resulted in rehousing being effected within a period of twelve months in most cases Examples of two such families are as follows:- (1) The mother from a very large and difficult Irish family, all of whom were at variance with society and the law. Her background was in consequence appalling. She was married at an early age, her husband was arrested on her wedding day and sentenced to a long term of penal servitude. She came to England as a Domestic Assistant, met her cohabitee, has two children and was reasonably happy until her family also came to England, broke up the cohabitation and lost her accommodation. She developed into a morose introvert. She was induced to accept temporary accommodation, her cohabitee was also admitted. The woman's family decided to return to Eire. Case work and a feeling of security completely changed the woman. She became very house proud, her flat was always spotless and the children well cared for. She was found Council accommodation in a converted house and occupied the upper part. This has now been very well decorated and would be a credit to any family. The woman still visits the office frequently for advice and is very contented. The cohabitee has remained in good employment for over two years which has contributed towards stability of the family. The original husband has completely disappeared and a divorce and marriage to the cohabitee is in progress. (2) The family consisting of a woman and six children, deserted by the husband, was evicted from single room accommodation for overcrowding and refusing an offer of temporary accommodation. She dispersed the family to the care of her friends. The three elder children, rather difficult males, were then admitted into Council care, and later two others, leaving the woman and one child. - 115 - The woman who was again pregnant, was determined to get rid of the child, and had booked in at a hospital under an assumed name, in order to abandon the child directly after birth. The woman was induced to accept temporary accommodation. After considerable case work, the two younger children were taken out of care. The seventh child was born, a female, and this, through the added security was accepted by the family. The three elder boys were introduced from care and joined the family in rotation. The family were trained to work as a unit, the added security helped and the whole family appeared to make daily progress. They eventually became a united family reasonably free from trouble and paying their way. They were rehoused in a flat near a London common, an ideal place for the children. The flat has been visited and is very well decorated and maintained by the mother. The children are happy, very well cared for, and the family continue to progress. Mothers and Babies Provision for unmarried mothers and their children is made under Section 21(l)(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. The Council have an arrangement with the London Borough of Lewisham whereby certain cases, such as emergency, physically handicapped and those in need of greater support, can be sent to their "Ballantyne" Mother and Baby Home at Lushington Road, S.E.6., which offers special facilities for such cases. The following tables show the numbers accommodated during the year:- (a) Voluntary Homes Mothers Children Total Number in residence at 31-12.68 13 6 19 ( 14) Admitted 54 54 108 (188) Discharged 54 54 108 (176) Number remaining at 31.12.69 13 6 19 ( 19) Country of Origin of Mothers Admitted: United Kingdom 22 Italy 2 Eire 20 West Indies 1 Australia 2 Mauritius 1 Spain 1 South Africa 2 Bermuda 1 Pakistan 1 China 1 Total 54 (94) (b) Other Homes "Ballantyne", Lewisham Mothers Children Total Number in residence at 31.12.68 3 2 5 Admitted 14 13 27 Discharged 15 13 28 Number in residence at 31.12.69 2 2 4 - 116 - Country of Origin of Mothers Admitted: United Kingdom 7 Italy 1 Eire 2 Spain 1 Uganda 1 Phillipines 1 St. Helena 1 Total 14 (10) "Carisbrooke", Lambeth Mothers Children Total Number in residence at 31.12.68 - - - Admitted - - - Discharged - - - Number in residence at 31.12.69 — — — Country of Origin of Mothers Admitted: Total Nil (1) 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, 1969:- Blind 405 (418) Partially sighted 124 (134) Physically Handicapped 1,514 (1352) Deaf/hard of hearing 69 (67) Elderly persons 4,592 (4493) Total of all Registers 6,704 (6464) 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 adaptwtions in the home, holidays, home chiropody treatment, meals on wheels, mobile library services and a laundry service in certain cases of chronic illness. - 117 - During the year 12.300 (11.290) 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. In addition, 1522 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 155. 0. 0. Southern Regional Association for the Blind 100. 0. 0. Royal National Institute for the Blind 250. 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 The Abbeyfield Society 40. 0. 0. National Association of Alms Houses 5. 0. 0. Cecil Homes 470. 0. 0. London Free Church Federal Council 75. 0. 0. Servite Houses (Hearth & Home Ltd.) 200. 0. 0. Task Force (1964) Ltd. 4000. 0. 0. Voluntary Hostels Conference 250. 0. 0. St. Joseph's Alms Houses 100. 0. 0. The Kensington Day Centre Ltd. 6490. 0. 0. Kensington and Chelsea Old People's Welfare Committee 3750. 0. 0. International Voluntary Service 75. 0. 0. The Irish Centre 100. 0. 0. Rowe Housing Trust 450. 0.. 0. In addition, the Kensington and Chelsea Old Peolple's Welfare Committee made the foiling grants from its funds:- Servite Old Age Pensions Club 60. 0. 0. Women's Institute 62. 0. 0. St. Mary Abbots Club 40. 0. 0. Task Force 20. 0. 0. Leisure Club for Disabled 25. 0. 0. West London Angling Club 5. 0. 0. National Old People's Welfare Council 5. 5. 0. Greater London Conference on Old People's Welfare 5. 5. 0. North Kensington Community Centre 35. 5. 0. Lancaster Road Old People's Club 15. 0. 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." - 118 - The number of persons newly registered as blind during 1969 was 57, twenty being men and thirty-seven women. Table I shows the distribution in age groups of the 405 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 educations, training and employment position is given in Tables III and IV. It will be seen that a total of 281 persons are over sixty-five years of age, leaving a total of 122 adults, of whom 50 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 70 members. Games equipment is provided and other activities included a 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 Department of Employment and Productivity, with whom consultation is arranged in cases of special difficulty. The number of home visits made to blind persons during the year was 1,484 (ls432). 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 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 Fire guards on loan Specially designed aids and gadgets. - 119 - TABLE I - BLIND PERSONS (REGISTERED) FOR THE YEAR ENDED 31ST DECEMBER, 1969, SHOWING THE DISTRIBUTION 31 AGE GROUPS OF THE BLIND POPULATION New cases in 1969 All cases (old and new) Male Female Total Male Female Total Under 1 year - - •m - - - (-) 1 year - - - - - - (-) 2 years - - - - - - (1) 3 years - - - - 1 1 (-) 4 years - - - - - (-) 5-10 years — — — 1 - 1 (1) 11 - 15 years — — - - mm - (1) 16 - 20 years - - I 3 5 8 (10) 21-29 years 1 - 1 12 6 18 (18) 30 - 39 years — - - 8 3 11 (15) 40 - 49 years — 1 1 10 11 21 (26) 5° - 59 years 2 2 4 19 13 32 (32) 60-64 years 2 4 6 10 14 24 (13) 65 - 69 years 2 3 5 10 18 28 (30) 70 - 79 years 10 11 21 23 76 99 (101) 80 - 84 years 1 5 6 8 51 59 (65) 85 - 89 years 2 8 10 12 49 61 (70) 90 years & Over - 3 3 9 33 42 (35) Unknown " - - - - - (-) 20 37 57 125 280 405 ( 418) TABLE II - ANALYSIS OF CAUSE OF BLINDNESS OF PERSONS NEWLY REGISTERED DURING 1969 Cause Male Female Total Retinal Arteriosclerosis 1 1 2 Retinal Degeneration 1 1 2 Detached Retina - 1 1 Cataract 2 10 12 Senile Macular Degeneration 6 6 12 Retinitis Pigmentosa - - - Diabetic Retinopathy 1 1 2 Vascular Retinopathy - 1 1 Myopia 1 1 2 Glaucoma 5 9 14 Trauma 2 1 3 Optic Atrophy 1 2 3 Others - 3 3 20 37 57 - 120 - TABLE III - SUMMARY OF OCCUPATIONS OF BLIND PERSONS AT 31ST DECEMBER, 1969 Male Female Total Children Aged 2-4 years - 1 1 Aged 5-15 years (educable) - - - attending special schools - - - attending other schools — - - (ineducable) in Hospitals for Mentally Sub-normal ! 1 - 1 Adults aged 16 years and upwards At schools - 1 1 Employed in sheltered workshops 2 1 3 Employed in open employment 37 21 58 Trainee for open employment 1 - 1 Unemployed but capable and available for work; already trained - 1 1 Subject to training for open employment 4 1 5 Subject to training for sheltered employment 1 - 1 Without training in open employment 2 - 2 Not available for work, aged 16 - 64 17 23 40 Not capable of work, aged 16 - 64 2 8 10 Not employed, aged over 65 58 223 281 TOTAL 125 280 405 TABLE IV - ANALYSIS OF THE OCCUPATION OF EMPLOYED BLIND PERSONS SHOWN IN TABLE III Sheltered Workshops Home Workers Schemes Open Industry Total Machine Tool Operators _ 1 1 Masseurs and Physiotherapists - — 1 1 Lecturers, Teachers - - 3 3 Barristers, Solicitors - - 4 4 Musicians - — 2 2 Proprietors, Managers _ - 6 6 Typists, Secretaries - — 18 18 Braille Copyists _ - 3 3 Clerical Workers - - 2 2 Telephone Operators • — 9 9 Shop Assistants - - 1 1 Boxers, fillers, packers mm- 1 1 Machine Knitters 1 - - 1 Basket Makers 2 — — 2 Piano Tuners — - 1 1 Domestic Workers - — 2 2 Other open employment - - 3 3 Placement Officer - - 1 1 : TOTAL 3 - 58 6l - 121 - PARTIALLY SIGHTED PERSONS There is no statutory definition in the National Assistance Act 1946, of partial sight, but the Department, of Health and Social Security 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 dsfectiva vision cr 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 l) shows a total of 124 (134), of whom 31 (31) were newly registered during the year (Table II). Training and Employment Severely handicapped There are fifty-six persons near and prospectively blind who require the full range of Welfare Services. Their circumstances are as follows:- Male Female Total Employed 3 5 8 Undergoing training 1 - 1 Awaiting suitable placement _ - - Not available for employment or not capable of work 3 41 44 7 46 53 (56) Requiring observation only - 8 8 (12) Industrially handicapped The remaining persons registered are classified thus:- Children aged 16 years and over still at school - 1 1 Employed 8 3 11 Undergoing training - 1 1 Available for and capable of training for work 2 - 2 Not available for work 8 40 48 18 45 63 (65) TABLE 1 - PARTIALLY SIGHTED PERSONS (REGISTERED) FOR THE YEAR ENDED 31ST DECEMBER, 1969, SHOWING THE DISTRIBUTION BY AGE GROUPS OF THE PARTIALLY SIGHTED POPULATION 0-l 2-4 5-15 16-20 21-49 50-64 65 and over Total Males - - — - 12 2 11 25 Females - - - 2 8 7 82 99 TOTAL - - - 2 20 9 93 124 (134) - 122 - 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 6 7 Females - - . - - - 24 24 TOTAL - - - - - 1 30 31 (31) TABLE III - REMOVAL FROM REGISTER DURING THE YEAR FOR REASONS 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 _ - _ _ - - 5 5 Females - - - - - 1 8 9 TOTAL . - - - - - 1 13 14 (ii) One Male (Group 65+) was decertified due to improved visual acuity. TABLE IV ANALYSIS OF CAUSES OF PARTIAL SIGHT OF PERSONS NEWLY REGISTERED DURING 1969 Cause Male Female Total Macular Degeneration 2 4 6 Cataract - 14 14 Hemianopia - 1 1 Glaucoma 1 2 3 Arteriosclerosis 1 1 2 Hypermoetropia mm 1 1 Optic Atrophy 1 - 1 Others 2 1 3 TOTALS 7 24 31 WELFARE OF THE BLIND AND PARTIALLY SIGHTED The number of appplications for registration as blind or partially sighted under the provisions of the National Assistance Act, 1948, has shown a decrease from those for 1963. The number of registrations as blind resulting from examinations has increased but the proportion of such registrations remains about the same. The Council continued to employ two consultant ophthalmologists for medical examination and assessment. - 123 - Details of examinations and findings are as follows:- 1969 1968 Number of examinations by Council's ophthalmologist 124 135 Number of hospital certificates accepted 42 35 Number of new cases registered-blind 55 51 Number of new cases registeredpartially sighted 32 30 Re-examinations: - Number previously registered as blind and now found to be partially sighted 1 1 Number previously registered as partially sighted and now found to be blind 13 14 Number previously registered as blind or partially sighted and now found to be not registerable 1 1 Number examined and no change found in category 57 71 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 services, 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,, 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 practicable in consultation with the Department of Employment ana Productivity to assist handicapped persons to secure any work for which they appear to be fitted and wish to obtain,. - 124 - (i) To take such steps as are practicable to assist handicapped persons who appear to be capable of benefiting from training under the Education Act, 1944, or the Disabled Persons Employment) Acts, 1944 and 1958, and wish to take advantage of such training. The Register of Handicapped Persons at 31st December, I960, showed a total of 1,514. During the year, 365 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 Department of Employment and Productivity. Relevant statistics are produced in Table I (Opposite page). An analysis of the disabilities of the newly registered cases is shown in Table II (page 126). Notifications concerning handicapped persons are received from many sources and the circumstances of each case are investigated at the earliest opportunity. Social welfare officers have carried out 5.104 home visits. Arising from these visits, many needs have been brought to notice and as a result 340 items of equipment have been supplied, comprising bath mats, bath boards, bath rails, bath seats, bath stools, bread cutters, commodes, braille clocks, long handled dust pans and brushes, writing frames, hoists, razors (mains and battery), raised toilet seats, walking sticks, wooden tap turners and stocking aids. This involved expenditure totalling £764. 9s. 6d. In addition, articles of medical loan equipment were issued where necessary. The sum of £680. 14s. 10d., (£6l6. 9s. 2d.) has been spent on special grants for handicapped persons on the following items Grab-rails in bathrooms and toilets Wiring of P.O.S.S.U.M. equipment Handrails by steps Ramp to back-door Complete adaptation to a flat Two examples can be quoted of help given to severely disabled residents of the Borough :- A man confined to a wheelchair was re-housed. Ramps were built, the bathroom door was widened and a folding-door fitted to facilitate the patient's mobility. A woman who had a leg amputation had a ramp built inside the backdoor leading to the garden. A wide concrete step at the front-door was halved and two shallow steps added to enable her to move with ease. - 125 - TABLE I - ANALYSIS OF PERSONS ON THE GENERAL CLASSES REGISTER ACCORDING TO AGE AND HANDICAP Code Major Handicaps Age Under 16 16-29 30-49 50-64 65 and over Total A/E Amputation - 2 3 11 22 38 F Arthritis or Rheumatism - 1 4 77 389 471 G Congenital malformations or deformities 3 1 2 6 12 24 H/L Diseases of the digestive and genito-urinary heart, circulatory and respiratory systems - 2 15 64 255 336 Q/T Injuries of head, face, neck, thorax abdomen, pelvis, trunk, limbs and spine 3 3 13 32 141 192 V Organic nervous diseases, epilepsy poliomyelitis, multiple sclerosis etc. 3 21 58 104 151 337 U/W Neuroses, psychose other than in *V* above s - 2 1 22 25 X&Y Tuberculosis, respiratory and non-respiratory - - 4 4 2 10 Z Diseases and injuries not specified - - 5 14 62 81 TOTAL 9 (9) 30 (30) 106 (95) 313 (273) IO56 (945) 1514 (1352) - 126 - TABLE II - NSW REGISTRATIONS DURING 1969. ANALYSIS OF DISABILITIES Disability No. of Persons No. of Persons Amputation of leg 2 Hysterectomy 1 Anaemia 3 Injured head 1 Angina 2 Injured legs 1 Arteriosclerosis 2 Injured spine 6 Arthritis 89 Kidney transplant } Arthrodesis of leg 1 Kyphosis 4 Asthma 8 Liver infection 4 Ataxia 1 Migraine 1 Bronchitis 20 Mongoloid 1 Carcinoma 15 Multiple sclerosis 8 Cardiac condition 48 Muscular dystrophy 1 Cirrhosis of liver 1 Neuritis 1 Club foot 1 Obesity 1 Colostomy 8 Oesophageal dilation 1 Crippled back (congenital) 2 Osteoarthritis 8 Diabetes 12 Osteomyolitis 2 Diverticulitis 1 Osteotomy 1 Emphysema 2 Parkinson's disease 6 Epilepsy 4 Poliomyelitis 4 Fractured femur 4 Rheumatism 3 Fractured hip 3 Sclerosis of lungs 1 Fractured pelvis 1 Senility 9 Fractured wrist 1 Spasticity 2 Gout 2 Spondylitis 4 Hemiplegia 30 Stroke 88 Hiatus hernia 1 Syringomyelitis 1 Hydrocephalus 1 Thrombosis 3 Hypertension 4 Tuberculosis (quiescent) 3 Ulcors (leg) 6 Ulcers (stomach) 3 TOTAL 365 TRANSPORT The Council has five vehicles (four coaches with hydraulic lifts and one utilabus) for transporting handicapped persons between their homes and social and rehabilitation centres, elderly persons to residential accommodation and homeless families and unmarried mothers to temporary accommodation. In addition, they are used for delivering aids and gadgets to the blind and handicapped, for taking residents of welfare homes on regular outings and on specially organised shopping trips, and delivery of meals from St. George*s Hall to Luncheon Clubs within the Borough. During the Council's organised holidays they transported the blind, handicapped and elderly to and from their homos to the assembly points and in some cases direct to and from holiday homes. A coach with a lift was stationed at the holiday camp in Kent to enable the elderly and handicapped to be taken on outings to nearby 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 services on over $00 occasions. The total mileage travelled in covering all these commitments amounted to 53,000 (50,000) miles. - 127 - WELFARE OF THE ELDERLY At 1st January, 1969, the number of elderly persons shown on the register was 4493» This figure represents an amalgamation of the register of elderly persons receiving visits from the social welfare officers and the register of case enquiries. This in effect produces a register of all old people known to the Department. During the year 930 new registrations were made and 831 persons were removed from the register, having either moved from the Borough, died or reregistered under some other category, i.e., blind, handicapped, etc. The number of persons remaining on the register at 31st December, 1969 totalled 4592. The services mentioned in this report were made available to give support to the elderly in their own homes. 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 elderly residents of 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 is carried out at St. George's Hall, Kensington Place, where approximately 1,290 meals a week are prepared, including those supplied to luncheon clubs. The preparation of meals for deliver in Chelsea is undertaken from the kitchen in King's Mead old people's home where an average of 330 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 foot hot. The charge to the recipient was l/- per meal. The total number of meals supplied was as follows:- January 8,08? February 6,562 March 6,795 April 6,128 May 7.973 June 6,328 July 6,452 August 8,285 September 6,141 October 8,059 November 7,335 December 6,356 84,501 (82,768) Of these 55»94l (52,916) were delivered by the Meals-on-Wheels service to elderly people in their own homes, the balance being delivered to luncheon clubs. The total number of persons in receipt of Meals-on-Wheels at the beginning of the year was 293 and on 31st December, 19^9» there were 334 persons in receipt of meals. - 128 - Laundry The Council has no direct authority to provide a laundry service. There does exist, however, a provision under Section 84 of the Public Health Act, 1936, whereby the Council is empowered 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 healths Fouled bed linen in cases of incontinence may be cleased under this Section. In order to comply with legal requirements, the Medical Officer of Health has been given a general authority by the Council to take whatever action appears to him to be necessary under the terms of the section. Action was taken in 80 (72) cases„ The bedding was marked, collected and laundered at the Council's disinfecting station at Silchester Road Baths and returned to the persons' homes. The provision of this service undoubtedly fulfils a much felt need. During the year 2820 (2424) separate collections of laundry were made and the number of articles cleansed totalled 34,654 (29,458). Holidays A booking for 200 active,, elderly people was arranged at Maddieson's Holiday Caiup, Littiestone-on-Sea, Kent. In order to satisfy the needs of the handicapped and to include residents of Part III homes a booking was made with the Little Oyster Holiday Camp, Minster, Isle of Sheppey. This camp has been specially adapted for use by handicapped persons. The staff on duty at this camp included members of the department from head office, residential homes, a coach driver, and members of the International Voluntary Service. Arrangements were made to accommodate the more severely disabled, at the Women's Royal Voluntary Services, Winged Fellowship at Crabhill House, near Redhill, Surrey. The total number of people for whom two weeks holiday was arranged was 370 (351)o of whom the majority were elderly, but some were blind and physically handicapped. The gross cost to the Council for all holidays was £7045 (£6840). SOCIAL AND REHABILITATION CENTRE The Centre which is in its fourth full year of operation provides a daily service to its members who are blind, physically handicapped or elderly. Membership on 31st December, 1969, was 122 (130). The staff consists of the Supervisor, Deputy Supervisor, Attendant, kitchen and cleaning staff and a handyman/porter. The main activity of the members is handicraft work under the instruction of tutors engaged through the Inner London Education Authority. Instruction in carpentry has recently been added to the already successful classes in hard and soft crafts and pottery. Transport is provided to take all the handicapped persons from their homes to the Centre in the morning and back to their homes in the evening. A substantial mid-day lunch together with morning and afternoon tea is provided. On their annual Summer Outing the members were taken to Brighton. The outing, which included a meal on the Pier, was greatly enjoyed by all. In October the Annual Open Day Sale of Work, which was again held in conjunction with "Help the Disabled Week", made it possible to display the high standard of work achieved by the members. This was reflected in the total sum raised from the sale of articles, £184. l6s. 7d., (£167. 5s. lid.). The Christmas party which was held at the Centre was very well attended and was most successful. - 129 - Task Force During the year, Task Force continued to operate in the Borough. Some 83O volunteers, enlisted from schools, youth clubs and groups, as well as individuals, were involved in providing help to the elderly. The average number of visits made to elderly persons each month was 1,276; regular visits were made to 350 persons. In addition, Task Force volunteers carried out 92 decorating and 1,352 jobs, such as window cleaning, gardening and escort duties. Much of the work performed by Task Force is done during the weekends, when the recognised statutory and voluntary services are not available. The number of volunteers recruited is encouraging as is the widening variety of tasks being undertaken. More elderly persons are benefiting as a result. 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. Relation with other voluntary organisations have been consolidated and an interchange of services and information continues to be satisfactory. The following services were provided in conjunction with the Kensington and Chelsea Old People's Welfare Committee:- Chiropody A domiciliary chiropody service was provided for home-bound elderly persons. The five chiropodists employed carried out 2237 visits to 489 individual persons. Administrative assistance for this service was provided by the British Red Cross Society. 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 1197 treatments were given to 300 elderly persons. No charge is made for the service. Libarary Facilities The Libraries Committee authorise the provision of suitable books including large print (Ulverscroft Print) for old peple confined to their homes. The books were distributed by the British Red Cross Society in the Chelsea area, and by the Women's Royal Voluntary Service in the Kensington area. The number of persons who benefited from the service was 177 (117)• 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 3,000 were distributed. In addition, and by arrangement with the Department of Health and Social Security, cards giving general information on how to obtain services are sent to persons reaching retirement age. Social Activities There are twenty-five social clubs for the elderly in the Royal Borough, unfortunately the Friendship Club (Notting Hill Synagogue) closed early in the year owing to lack of support, but several members were able to transfer to other clubs. Old Time Dancing and Arts and Crafts classes continue to be held at the Chelsea and North Kensington Community Centres. - 130 - The main object of the clubs is to provide facilities where the elderly of both sexes can meet in a friendly and congenial atmosphere. Concerts, outings and other social activities are also arranged by the club organisers. 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 630 elderly persons. In addition, 2,556 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 night Christmas shopping facilities. The store remained open until 8.30 p.m. and 300 people from this and adjoining boroughs took advantage of the opportunity which was greatly appreciated. A party of 300 elderly people were taken on a day outing to Brighton; cost of this venture was met by funds raised by the Caius Boxing Club at a tournament held in the Chelsea Old Town Hall. Other Voluntary Services During the year some 114 unattached voluntary visitors have been visiting regularly one elderly person each. The very active Good Neighbour schemes have expanded to cover most of the Borough. Over 277 voluntary visitors from churches in the Borough of all denominations, as well as individuals, are providing a very valuable contribution to this work. Both individual volunteers and volunteers attached to the Good Neighbours schemes have shown an increase during the past year and there is reason to believe that an even larger number of volunteers will be forthcoming in the future. 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 Council's Liaison Officer for Voluntary Services whose help and advice have been warmly welcomed by many voluntary organisations. It is of interest to note that during the past year some eighteen talks have been given to organisations and groups of people regarding the welfare services available to the handicapped and elderly of the Borough. The Voluntary Appeals Committee which was formed as a sub-committee of the Old People's Welfare Committee continued their money raising projects. In November, a Michaelmas Fair was organised at the Kensington Town Hall and resulted in the sum of £1,130. 6s. 9d., being given to the parent body. The proceeds are being used to meet urgent needs of the elderly which cannot be met from statutory or other sources. To help meet the cost of an increased number of Christmas parcels for distribution to the elderly, the Committee arranged for collection boxes to be placed in public houses etc., and the sale of suitably inscribed book matches. Together these efforts raised a sum of £193. 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 occupation therapy, a chiropody service, hairdressing and bathing facilities, library services and mid-day meals. Attendances average sixty per day. - 131 - Two hydraulic tail-lift coaches with drivers, are provided by the Council to transport the handicapped to and from the Centre. The work of the Kensington Day Centre makes a valuable contribution to the services provided by the Council and is greatly appreciated. OTHER FEATURES OF THE WORK OF THE DEPARTMENT Determination of Liability of the 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 the Department of Health and Social Security. It has not been necessary 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 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 number 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 31st December, 1.969, there were registered with the Council fifteen voluntary homes providing 723 beds, and one privately run home providing eight beds. 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 four 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 moveable 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. As at 1st January, 1969, the property of 39 people was being stored, and in twelve instances houses and flats had been secured against unauthorised entry. During the year 155 (175) cases were dealt with. It was possible to trace relatives in forty cases and arrange for them to accept responsibility. The property of 15 people was sent to the hospitals in which they were patients. Of the remainder, 46 patients' belongings were taken into store, 20 premises were secured (there being no moveable property), and 16 lots of property were destroyed with either the patient's consent or with the approval of the Welfare Committee. Of the total of 206 properties, 172 were satisfactorily resolved, and at 31st December, 1969. there remained six homes under surveillance and the property of 28 people still remained under care and protection in store. - 132 - 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 39 (33) persons. The following is a summary of the action taken:- Cases where funeral expenses have been fully recovered 19 (16) Cases where part only of the expenses have been recovered 6 (11) Cases where full cost has been borne by the Council 14 (6) Cost of burials £1115. 8s. 0d. (£909. 2s. 0d.) Amount recovered £ 600„ 13s. 2d. (705• 15s. 9d.) Net cost to the Council £ 514, l4s. l0d. (£203. 6s. 3d.) In addition 45 burials or cremations were arranged for persons resident in the Council's homes at the time of death, which are summarized as follows:- Cases where funeral expenses have been fully recoverd 21 (22) Cases where part only of the costs have been recoverd 7 (12) Cases where the full cost has been borne by the Council 17 (7) Cost of burials £1296. 19s. 0d. (£1013. 5s. 9d.) Amount recovered £ 901. 9s. 6d. (£ 735. l4s. l0d.) Net cost to the Council £ 395. 10s. 3d. (£ 277. 10s. 11d.) Settlement of Estates When a persons dies, 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, 1969, there were 48 estates outstanding. During the year 132 estates were referred for settlement. l41 estates were wound up involving receipts and payments of £5,068 and at 31st December, 1969, a total of 39 estates were still in hand. Receiverships The Chief Welfare Officer is designated to act as Receiver, by order of the Court of Protection, of the property of persons who are deemed to be mentally incapable of managing their own affairs. - 133 - 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 moneys, 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 them, to 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, 1969, there were seven persons for whom the Chief Welfare Officer was appointed as Receiver. During the year four died and one new order was taken,, leaving a total of four Receivership cases with estimated value of £40,732. 9s. 3d., and for whom a total sum of £6,182. 17s. l0d., was disbursed during the year. Application for Receivership Orders have been made to the Court of Protection in three further instances. 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, 1951s 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, and are not receiving from other persons, proper care and attention. Although several cases were visited and investigated during the year, it was only necessary to take action in the case of two women. Both were admitted to King's Mead where one later died. TRAINING OF SOCIAL WORK STAFF During the course of the year two trainee social welfare officers were successful in obtaining places on a full-time two year training course. One of these was seconded to the course by the department and will return after training. One of the social welfare officers was similarly successful and has likewise been seconded to the course on the understanding that she will return to the department when she has qualified. Two social welfare officers seconded to full-time training two years ago successfully completed their course and have been awarded the certificate in social work. They are now back at work in the department. At the end of the year a total of four members of the field work staff were undergoing full-time training. No new trainee social welfare officers were recruited during the year. Arrangements were made for those already in the department to broaden their experience by being given an opportunity of spending short periods in the social work department of local hospitals and in other agencies. A number of the field work staff attended courses and seminars arranged by the London Boroughs Training Committee and other bodies. Students from Other Organisations Students from professional social work courses were again accepted in the department and were supervised by professionally qualified staff. Other students spent periods in the department including one from a - 134 - degree course in sociology who spent the whole of the autumn term with the department at the request of his university. Trainee social workers from other sections and departments including the Mental Health Service spent periods of a week working with the social welfare staff. On two occasions students from Schools of Architecture visited the welfare section to discuss the needs of various groups of people in the community. There is a growing tendency for students in professional disciplines such as architecture to be encouraged to broaden their knowledge of the social environment. The staff find this interchange of ideas and experience very stimulating. Home for the Elderly - Dovehouse Court Home for the Elderly - Dovehouse Court The Dining Room - Dovehouse Court Section 8 MISCELLANEOUS SERVICES - 135 - MISCELLANEOUS SERVICES EMERGENCY CALL SERVICE This service co-ordinates emergency cover for local authority health, welfare and children's emergencies arising outside normal office hours. It is shared between this Council and the City of Westminster and is operated from Westminster City Hall. The cost is divided between the two authorities. During 19^9t 1*042 calls were received by the Night Duty Officers, which necessitated summoning, or consultation with, this Councils services. The comparable figure in 1968 was 1,056. NURSING HOMES There were no new registrations of nursing homes during 1969 but at two homes, the Keepers proposed that rooms previously used as staff or private accommodation should be registered for the reception of patients. Subject to certain requirements being met, this was regarded as satisfactory and registration was being implemented at the end of the year. The Keepers of another home intimated their intention to close the home and the patients have been gradually transferred elsewhere so that cancellation of registration can be effected early in 1970. A fire occurred at one of the larger homes in October. The London Fire Service arrived at the premises very quickly and many patients were evacuated by nursing staff to the adjoining house which is occupied by the Keepers of the Home. The fire was soon under control, there was no injury to staff or patients and very little damage to the building. On the following day, the home was functioning normally. During the year, seven visits of inspection were made by a principal medical officer and the chief public health inspector and at two homes they were accompanied by an officer of the Borough Engineer and Surveyor's Department to advise on "means of escape". One visit was also made by the Borough Surveyor's Officer and a Public Health Inspector. All homes were found to be generally satisfactory and apart from a certain amount of redecoration on one home, no extensive works were required. 136 1968 1969 Number of homes registered on 1st January 9 8 Number of registrations cancelled during the year 1 Nil Number of homes remaining on the register at 31st December 8 8 Total number of beds at 31st December 202 202 Registered for medical patients only 157 157 Registered for medical or surgical patients 38 38 Registered for medical or maternity patients 7 7 Registered for surgical or maternity patients Nil Nil Inspection by medical officer and/or public health inspector 13 8 WATER SUPPLY The water supply in Kensington and Chelsea is almost entirely provided by the Metropolitan Water Board, but there are three 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. 137 Flouridation 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 30 Faeces and rectal swabs 827 Urine 134 Milk (bacteriological) 43 Water (drinking) 17 Water (swimming) 53 Ice cream 32 Miscellaneous 49 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 727 which included 145 cases in which there were inquests. PARKING CONTROL All applications for free parking facilities on grounds of physical disability are referred to the Medical Officer of Health for consideration and advice. Where necessary, applicants are requested to attend for a medical examination. During the year, 130 applications were received, 92 were granted and 38 were refused. 138 STAFF MEDICAL EXAMINATIONS During the year, the Council's policy was continued, namely, of no longer requiring propective 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 567 Number referred for medical examination 15 Number failing to pass 15 Number referred for further opinion 1? Number required to be re-examined within twelve months 4 In addition, 13 members of the staff who had been on prolonged sick leave were referred for my opinion as to their suitability to continue to be employed on their existing duties. Five medical examinations were carried out at the request of other local authorities. INDEX Page Adoptions 26 Adulteration of Food 103 Advice Leaflets 129 Amusements with Prizes - Permits 94 Area of Borough 11 Artificial Kidney Machines 40 Artificial Lighting of Common Staircases 77 Atmospheric Pollution - Clean Air 73-76 "At Risk11 Register 27 Bacteriological and Analytical Work 137 Basement Bakehouses 79 Bathing Centre 56 BCG Vaccinations 44, 45, 56 Births l, 2, 11 Blindness 117-123 Boarding-Out of Children 26 Borough Co-ordinating Committee 51 Burials and Cremations . 132 Cancer 28 Care and Protection of Property 131 Care of Mothers and their Young 23 Causes of Deaths 14-15 Celluloid and Cinematographic Film-Registration for storage 93 Certificates of Disrepair 100 Cervical Cytology 28—31 Child Minders 25 Children "At Risk" 27 Chiropody 45,46,129 Clean Air Act 73-76 Clearance Areas 96,97 Clinics and Treatment Centres: Ante—natal 23 E.N.T. 55 Hearing 54, 55 Minor Ailments 55 Special Investigation 55 Speech 55 Vision 54 Closing Orders 100 Community Care 64 Composition of Milk 90 Compulsory Removal under Sec. 47 of N.A. Acts, 1948 & 1951 133 Congenital Malformations 27 Consumer Protection Act 72 Coroner's Court 137 Creches 24 Cytological Diagnosis of Early Uterine Carcinoma 28-31 Page Day Nurseries 24-25 Deaths 1,3,4, 11-15 Demolition Orders 100 Dental Health Education 48, 59 Dental Service 59-62 Diphtheria 19 Diphtheria Immunisation 43 Discretionary Grants 98, 99 Disease (Notification) 16-21 Diseases of Animals Act 71 Disinfection and Disinfestation 69 Domiciliary Midwifery 34 Dysentry 19 Emergency Call Service 135 Employment Agencies & Nurses Agency Licences 93 Enteric Fever 19 Environmental Health Services 67-106 Estates, Settlement of 132 Explosives-Registration for Storage and Sale 94 Factories and Workshops 77-79 Family Planning 31-33 Family Planning Association 32 Family Welfare Association 51 Fertilisers and Feeding Stuffs Act 71 Fireguards-Loan of 51 Fluoridation 137 Food and Drugs Act 86-92 Food Poisoning 19 Food Premises-Inspection and Registration 86, 87 Food Sampling 88 Food Surrendered. 88 Foreign Bodies in Food 88 General Improvement Area 97 Grants and Loans 40, 98, 99 Greater London Council (General Powers) Act, 1968 84 Handicapped and Elderly Person 116, 117, 123-126 Handicapped Children 27, 53 Health Committee 8 Health Education 47, 49-51 Health Education in Schools 48-49 Health Visiting 35-38 Holidays for Old People 128 Home Help Service 41 Home Nursing 38-40 Home Safety 49 Homeless Families 113-116 Homes for Old People 108, 111 Hospital Admissions (Mentally Sub-normal) 63 House Purchase Loans 99 Housing 95—101 Housing Priority on Medical Grounds 101 Ice-Cream 91,92 Illegitimate Births 16 Immunisation and Vaccination 42-45, 56 Improvement Grants 98, 99 Infant Mortality 2, 11,12 Infectious Diseases 2 -4, 16-21 Infectious Illness in Schools 57 In-Service Training 37 Inspections and Supervision of Food Premises 86, 87 International Certificates 21 Introduction 1-7 Kensal New Town Clearance Area 96 Kensal New Town Health Centre 24 Kensington Day Centre Limited 130 King,s Mead 108 Lancaster Road (West) Area 97 Land Charges 83 Laundry Service for the Aged Incontinent 128 Legal Proceedings 102-103 Legal Proceedings in relation to Food Hygiene 104-106 Library Facilities for Old People 129 Licensing Act 84 Licences for Public Entertainment 84 Licensing and Registrations 92-95 Liquid Egg (Pasteurisation) Regulations 92 Loan of Home Nursing Equipment 40 Loans and Grants 40 Malaria 19 Marriage Guidance 33 Massage Establishments 94 Mass Radiography 45 Maternal Deaths 2, 12 Maternity and Child Welfare 23, 62 Meals—on—Wheels 127 Medical Examination of Staff 138 Medical Inspection at Schools 53 Medicinal Baths 69 Mental Health Service 2, 63-66 Midwifery 34, 35 Midwives Act 35 Milk 89—91 Miscellaneous Services 135-138 Mortuary Facilities 137 Neonatal Deaths 12 Night Cafes 84, 85 Noise Abatement Act 76 Notification of Congenital Malformations 27 Notification of Diseases 16-21 Nottinghill Neighbourhood Service 65 Nurseries 24-25 Nursing Homes 135-136 Nursary Nursing Staff 24 Obstetric Nurse Training 35 Occasional Creches 24 Officers of the Health and Welfare Services 9-10 Page Offices, Shops and Railway Premises Act 80-83 Oil Heaters 2 Ophthalmia Neonatorum 19 Old People's Welfare 127-131 Outworkers 79 Overcrowding 100 Parking Control 137 Partially Sighted Persons 121-123 Personal Cleansing 69 Personal Health Services 23-52 Personal Hygiene in Schools 55 Pet Animals Act 72 Pharmacy and Poisons Act 72 Play Groups 25 Poliomyelitis 19 Poliomyelitis Immunisation 43 Population 11 Preface 1—7 Prevention of Damage by Pests Act 70-71 Prevention of Illness, Care and After-Care 45-51 Psychiatric Day Centre 63 Psychiatric Social Club 64 Qualification Certificates 99 Rag Flock and Other Filling Materials Act 72 Rateable Value 11 Rats and Mice 70—71 Receiverships 132—133 Recuperative Holidays 46-47 Refreshment Houses Acts, 1860-1967 85, 86 Registration of Food Premises 87 Registration & Inspection of Voluntary & Private Homes for the Aged and Infirm 131 Remedial Foot Classes 56 Residential Accommodation for the Elderly 108 Residential Care of the Mentally Sub-normal 64 Riding Establishments Act 71 Rodent Control 70—71 Sanitary Inspection 68-69 Scabies 69 School Health Service 53-57 Screening Tests of Vision and Hearing 54-55 Settlement of Estates 132 Shops Act 94, 103 Slaughterhouses 92 Slum Clearance 96,97 Smallpox 19 Smallpox Vaccination 44 Smoke Control Areas 73—75 Social and Rehabilitation Centre, Social Activities 128, 129 Staff 9-10 Standard Grants 98, 99 Statistics Dental Health 6l, 62 Environmental Health 68-83, 87-92, 95 Page Mental Health 66 Personal Health 23-52 School Health 54-57 Vital and Social 11-16 Welfare 103—113 Stillbirths 11 Strike of Refuse Collectors 101 Sub-normal Children 65 Suicide 4 Surrender of Unfit Food 88, 89 Swimming Baths 136 Task Force 129 Temporary Accommodation 108, 113, 116 Tetanus Immunisation 44 Theatrical Employers - Registration 93 Town Planning Applications 84 Training Centres for the Mentally 111 64-65 Training of Pupil Midwives 35 Training of Social Work Staff 133 Transport of Handicapped Persons 126 Tuberculosis Care and After-Care 20—21 Notifications, deaths, etc. 20-21 Vaccination 44—45 Visiting 20 Unclean Milk Containers 90 Unmarried Mother and her Child 33 Unfit House and Parts of Houses 100 Unsound Food 88 Vaccination and Immunisation 42-45 Venereal Disease 52 Vital Statistics 11-16 Voluntary Visiting of the Elderly 130 Voluntary Homes for the Aged and Infirm 112 Water Supply 136 Welfare Services 107-134 Welfare 0ommittee 8 Welfare Grants to Voluntary Organisations 117 West London Family Service Unit 31 Whooping Cough Immunisation 43 x—ray Units 45 Young Chronic Disabled 96 Young Persons (Employment) Act 94