KEN 79 THE ROYAL BOROUGH OF KENSINGTON AND CHELSEA ANNUAL REPORT ON THE HEALTH AND WELFARE OF THE BOROUGH FOR THE YEAR 1970 D. J. SHEERBOOM M.B., B.S., D.P.H. MEDICAL OFFICER OF HEALTH t 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 OTHER HEALTH SERVICES (Full index at back of the Report) THE ROYAL BOROUGH OF KENSINGTON AND CHELSEA With the Compliments of the Director of Health Services 25A, Kensington Square, London, W8 5HW Tel: 01 - 937 5464 THE ROYAL BOROUGH OF KENSINGTON AND CHELSEA ANNUAL REPORT ON THE HEALTH AND WELFARE OF THE BOROUGH FOR THE YEAR 1970 D. J. SHEERBOOM M.B., B.S., D.P.H. MEDICAL OFFICER OF HEALTH 1 THE ROYAL BOROUGH OF KENSINGTON AND CHELSEA Telephone: 01-937 5464 Health Department, 25A, Kensington Square, London. W. 8. October, 1971. To: The Mayor, Aldermen and Councillors of the Royal Borough of Kensington and Chelsea. My Lord, Ladies and Gentlemen, I am privileged to submit the Report on the Public Health and Welfare Services in Kensington and Chelsea for 1970, although I was not responsible for any of the services in the Borough during the year under report, since my appointment was not effective until March 1971. As Dr. J.H. Weir mentioned in the introduction to his Report for 1969. that was the last complete year for which he was responsible as Director of Health and Social Services and Medical Officer of Health. He retired on 25th October, 1970 and he was therefore responsible for the work of his department throughout the greater part of the year. Following his retirement, his Deputy, Dr. P.J.C. Walker, became Acting Medical Officer of Healths. Dr. Weir and then Dr. Walker, were responsible for the whole range of Health, Welfare and Children's Services. The Annual Report in respect of the Public Health of the borough is required for the Departments of Health and Social Security and of Education and Science (so far as it relates to the School Health Service) and it was the practice to include the related welfare services provided by the Council. There is a statutory duty to make a return annually to the Home Office in respect of the Children's Service. For this reason, although the Director had this responsibility for the three services, it was not his practice to include the Children's Service in his Annual Report and it is proposed to follow this precedent for the year 1970. An additional reason for this is that, as a result of the Local Authority Social Services Act, 1970, a Social Services Committee was set up, holding its first meeting towards the end of the year under report. A Social Services Department under the direction of the Director of Social Services began to function from the beginning of 1971p and became responsible for the Children's and Welfare Services. Other services provided under the National Health Service Act, 1946, relating to the day care of children; their care and after-care; the social care of mothers and young children; the home help service and the mental health service will all be taken over from 1st April, 1971. In opening this introduction I used the word 'privileged' advisedly, for two reasons. As Dr. Weir's deputy over a period of seven years I benefited greatly firstly from his almost limitless experience of public health and local government matters which crystallised in the advice he gave me and secondly I knew in advance the effectiveness of the organisation which he had so carefully built up. October 25th, 1970 was a sad day for this Department, for the Borough and for public health as a whole. In fact, it was in many ways the end of an era. Dr. J.H. Weir had been the Medical Officer of Health for the original two constituent Boroughs, the Royal Borough of Kensington and the Metropolitan Borough of Chelsea, since February, 1950 and he continued as Medical Officer of Health from April 1st, 1965, for the new 2 combined Royal Borough of Kensington and Chelsea until his retirement. He was a Medical Officer of Health who held strongly to the original concept of preventive principles in all aspects of public health, preventive and social medicine and the Borough owes him a very great deal. He was an excellent and prolific writer on many subjects, was always highly sought after as a speaker and he earned, and fully deserved, an international reputation in the field of Public Health generally. As he himself stated in his Annual Report for 1969, he had seen many changes take place in the Borough during his period of office, most of them for the better, though he viewed the possible future organisation for all Health and Social Services with some foreboding. I must also express my gratitude to Dr. Walker both as Dr. Weir's very able Deputy and in the acting capacity which he held for a period of several months in circumstances of increasing difficulty. He maintained the high standard of work in and service by the department, this made my take-over of responsibility from him much easier than otherwise would have been the case. Both Dr. Weir and Dr. Walker during the whole of the period under reports had not only to cope with the normal duties of their department but also the very considerable additional responsibilities which the setting up of the new Social Services Department placed on their shoulders. In addition to the retirement of Dr. Weir, there were a number of other changes of senior staff in the department. Mr. M.C. Downer, the Principal Dental Officer, left to take up a Research Fellowship with Manchester University and although an appointment was made his position could not be filled before the end of the year. Mrs. M. Smith, the Assistant Principal Social Worker (Health Services), left to take a similar position with the London Borough of Hammersmith and her place was taken in October by Miss R. Wurtzburg. Mr. D. Tinson joined the service from the London Borough of Lambeth on 1st April, 1970, as Deputy Chief Administrative Officer. Mrs. J. Milne and Mrs. H. Porebska, who had both been part-time dental officers, joined the full-time staff. Vital Statistics Population - The population estimated by the Registrar General is 203,730 and compares with 208,480 in 1969. Birth Rate - The number of live births per 1,000 population of the borough was 12.3 as in the previous year. Death Rate - The number of deaths per 1,000 population in 1970 was 10.6 and compares with 10.4 in the previous year. The following table gives the adjusted Kensington and Chelsea birth and death rates compared with the rates for London and for England and Wales for the year 1970:- Kensington and Chelsea adjusted Inner London Greater London England and Wales No. of births per 1,000 population 7.4 15 15.2 16 No. of deaths per 1,000 population 10.5 11.6 11.3 11.7 3 Infant Death Rate - This rate for 1970 was 21.5 (18 in the previous year). The rates for Inner London,, Greater London and for England and Wales were respectively 20.4, 17.8 and 18. Neo-natal and Early Neo-natal Deaths - The rates for both categories showed an increase to 36 and 29 respectively,, compared with 29 and 24 in 1969. Of these deaths a half took place grossly prematurely and it may be assumed before twenty-six weeks and the foetus was viable. It is impossible to assign a cause with certainty but prematurity is often due to stress in pregnancy and in my view the following were contributory, if not causal factors, in many cases. Unsuitable employment of the mother which is too far from her home, working too late in pregnancy, a diet which is often not satisfactory and too much being expected of the mother by the husband in the way of financial support. Maternal Death Rate - One maternal death occured giving a rate of .39 per 1,000 live and stillbirths. Of the 7 maternal deaths recorded in the six years from 1965, including this maternal death, five were abortions of which certainly three were induced. Rates excluding deaths due to abortion are for Inner London 0.25 and Greater London 0.17. Illegitimate Births - The rate per 1,000 live births is 160 as against 194 last year. There has been a marked reduction following the much slower reduction in rate over recent years. Whilst it is not possible to be certain of the cause it is reasonable to assume that this results from contraception (mainly the pill) and wider facilities for termination of pregnancy operating to eliminate "high risk" unwanted pregnancies with a higher proportion of wanted babies born to couples in stable cohabitation. Infectious Diseases No specially note-worthy cases were recorded. Health Education Without good communication there can be no effective health education and in this connection it is pleasing to note that in 1970 the highest number of talks (1,451) to the largest aggregate audience (15,64l) were recorded since 1965, an increase of some 25% over the previous year. These talks have ranged from frequent friendly chats to small groups of mothers in health centres to more formal addresses to larger gatherings. Whilst it is true that the officers taking part are from a wide range of disciplines, the department's health visitors may reflect with satisfaction that they have been responsible for some 83 per cent of them. Improvement Grants This is the first full year in which the provisions of the Housing Act 1969 have been operative and a significant increase in the number of improvement (discretionary) grants has resulted. Approval was given to 704 grants amounting to £649,006 compared with 246 grants amounting to £76,651 in the previous year. The marked increase is a direct reflection of the impetus given by the new Act. Judging from the number of inquiries received before the end of the year the total number of grants approved is likely to be exceeded in 1971. 4 Welfare Services The Chronically Sick and Disabled Persons Act 1970 became law on 29th May, 1970, and although a number of its provisions were operative during the year it was considered inadvisable to endeavour to implement these in anticipation of the setting up of the Social Services Department. To a limited extent, services indicated were already in existence and regard where practicable was had to the intentions of the Act in planning ahead. This is the last occasion since 1948 when the Annual Report of a Medical Officer of Health can contain the comprehensive account of all the community health services provided in the Royal Borough. Already a very considerable part of these services has been transferred to the Social Services Department and there is a clear indication that it is only a matter of relatively short period of time before the remaining personal health services and probably the school health service will become the responsibility of an integrated ad hoc authority. There is however a very wide field for the development of services. With this thought for consideration I have had the honour to be Your obedient Servant, D.J. SHEERBOOM Director of Health Services 5 MEMBERSHIP OF THE HEALTH COMMITTEE (as at 31st December, 1970) The Mayor (Alderman Edward Thorn) The Deputy Mayor (Alderman F.W. Marshall) Alderman Lady Petrie Councillor Mrs. J.A. Albert " Miss Elizabeth M. Christmas (Chairman) " James R. Ferard " Mrs. Muriel Gumbel, J.P. " D.H.C. Pritchard " Mrs. Pat Seers " Mrs. Brian Sundius-Smith (Vice Chairman) " S.L. Tanner " G.R.G.C. Tickler, M.A. " Miss Doreen M. Weatherhead, M.S.R., S.R.R. Non-Council Dr. J.F.L. King (Inner London Local Medical Committee) Members Mr. J.A. Paterson-Morgan, J.P., F.L.A.S. MEMBERSHIP OF THE WELFARE COMMITTEE (as at 31st December, 1970) The Mayor (Alderman Edward Thorn) The Deputy Mayor (Alderman F.W. Marshall) Alderman Lady Petrie Councillor Mrs. J.A. Albert (Vice Chairman) " Miss Elizabeth M. Christmas " Michael Farrow, M.A. " Harvey Gresty " The Hon. Archie Hamilton " J.A.C. Hill " Miss Barbara Hulme, B.A. " L.A. Kenny (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. 6 PRINCIPAL AND SENIOR OFFICERS OF THE HEALTH AND WELFARE DEPARTMENT AS AT 31ST DECEMBER, 1970 Acting Medical Officer of Health and Principal School Medical Officer and Deputy Director of Health and Social Services 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 Principal Dental Officer (Vacant position) Dental Officers (Whole-time) MRS. M.C. McNICHOLL: MRS. J. MILNE MRS. N. POREBSKA 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 Assistant Principal Mental Welfare Officer mr. p.s. Mcdowell 7 Chief Supervisor Combined Adult Training and Psychiatric Day Centre MR. R.F. POTTER Deputy Chief Supervisor MR. J.M. ANDERSON Supervisor of Day Centre MISS L.P.M. STAUNTON Supervisor of Junior Training Centre MISS K.A. BAILEY Principal Social Worker (Health Services) MISS J.F. FEELY Assistant Principal Social Worker (Health Services) MISS R. WURTZBURG 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 MR. D. TINSON 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 9 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 1970 203,730 Average density of population per acre 69.O RATEABLE VALUE Rateable value of the borough at 1st April, 1970 £26,443,885 Estimated net product of a penny rate 1970/71 £ 104,800 Estimated number of separately assessed dwellings at 1st April, 1970 60,670 LIVE BIRTHS Males Females Total Legitimate 1,048 992 2,040 Illegitimate 253 220 473 Totals 1,301 1,212 2,513 Crude birth rate per 1,000 of the estimated population 12.3 Adjusted birth rate for comparative purposes (Area comparability factor= 0.60)* 7.4 STILLBIRTHS Total (22 males and 10 females) 32 Rate per 1,000 total live and stillbirths 12.6 DEATHS Total (968 males and 1,187 females) 2,155 Crude death rate per 1,000 population 10.6 Adjusted death rate (Area comparability factor= 0.99)* 10.5 INFANT MORTALITY Infant deaths (all deaths of liveborn children under one year) Males Females Total Legitimate 28 17 45 Illegitimate 6 3 9 Totals 34 20 54 COMPARABILITY OF RATES (*) The area comparability factors for use with crude birth and death rates contain adjustments for boundary changes and make allowances for the way in which the sex and age distribution of the local population differs from that for England and Wales as a whole. In addition, the death area comparability factors have been adjusted specifically to take account of the presence of any residential institutions in each area. When local crude birth and death rates are multiplied by the appropriate area comparability factor, they are comparable with the crude rate for England and Wales or with the corresponding adjusted rate for any area for that year. 10 Death rate of all infants per 1,000 livebirths 21.5 Death rate of legitimate infants per 1,000 legitimate livebirths 22 Death rate of illegitimate infants per 1,000 illegitimate livebirths 19 Death rate of male infants par 1,000 male livebirths 26.1 Death rate of female infants per 1,000 female livebirths 16.5 Neo-natal deaths (under 4 weeks of age) (24 males and 12 females) 36 Males per 1,000 male livebirths 18.4 Females per 1,000 female livebirths 9.9 All infants per 1,000 livebirths 14.3 Early neo-natal deaths (under 1 week of age) (21 males and 8 females) 29 Males per 1,000 male livebirths 16.1 Females per 1,000 female livebirths 6.6 All infants per 1,000 livebirths 11.5 Perinatal mortality (deaths under 1 week plus stillbirths) (43 males and 18 females) 6l Males per 1,000 live and still male births 32.5 Females per 1,000 live and still female births 14.7 All infants per 1,000 live and stillbirths 24.0 MATERNAL DEATHS Maternal deaths (Abortion) 1 Maternal mortality rate per 1,000 live and stillbirths .39 DEATHS FROM CERTAIN CAUSES Tuberculosis of respiratory system 4 Other forms of tuberculosis 2 Respiratory diseases (other than tuberculosis) (Code Nos. B31, B32, B33(l), B33(2), B46(7)) 299 Cancer (Code Nos. B19(l), (2), (3), (4), (5), (6), (7), (8), (9), (11)) 415 Heart and circulation diseases (Code Nos. B26, B27, B28, B29) 640 Suicide 62 11 SUMMARY OF VITAL STATISTICS FOR KENSINGTON AND CHELSEA in 1970 (Compared with previous ten years) Year Total Population Total Deaths Crude Death Rate Total Births Crude Birth Rate Total Infant Deaths Infant Mortality Rate 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 1970 203,730 2,155 10.6 2,513 12.3 54 21.5 12 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN 1970 Disease Code No. All Ages Under l yr. 1 yrs. and under 5 5 yrs. and under 45 45 yrs. and under 65 65 yrs and over Enteritis and other Diarrhoeal Diseases B4 1 1 – – – – Tuberculosis of Respiratory System B5 4 – – 1 1 2 Other Tuberculosis B6( 2) 2 – – 1 1 – Meningococcal Infection Bll 1 – – 1 – – Syphilis and its Sequelae B17 4 – – – 1 3 Other Infective and Parasitic Diseases B18 4 3 – – – 1 Malignant Neoplasm, Buccal Cavity etc. B19(l) 7 – – – 3 4 Malignant Neoplasm, Oesophagus B19(2) 9 – – – 2 7 Malignant Neoplasm, Stomach B19(3) 35 – – – 8 27 Malignant Neoplasm, Intestine B19(4) 55 – – – 14 41 Malignant Neoplasm, Larynx B19(5) 3 – – – 1 2 Malignant Neoplasm, Lung, Bronchus B19(6) 110 – – – 47 63 Malignant Neoplasm, Breast B19(7) 45 – – 2 23 20 Malignant Neoplasm, Uterus B19(8) 18 – – 1 10 7 Malignant Neoplasm, Prostate B19(9) 10 – – – 2 8 Leukaemia B19(10) 11 – – – 4 7 Other Malignant Neoplasms B19(ll) 123 – – 13 41 69 Benign and Unspecified Neoplasms B20 8 – – – 5 3 Diabetes Mellitus B21 15 – – 1 2 12 Other Endocrine etc. Diseases B46(l) 6 – – – 1 5 Anaemias B23 5 – – 1 1 3 Other Diseases of Blood, etc, B46(2) 5 – – 1 1 3 Mental Disorders B46(3) 10 – – 6 2 2 Meningitis B24 2 – – 1 1 – Multiple Sclerosis B46(4) 3 – – – 1 2 Other Diseases of Nervous System B46(5) 21 2 – 2 5 12 Chronic Rheumatic Heart Disease B26 45 – – 17 7 21 Carried forward 562 6 – 48 184 324 13 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 Brought forward 562 6 — 48 184 324 Hypertensive Disease B27 29 — — — 3 26 Ischaemic Heart Disease B28 449 — — 7 114 328 Other Forms of Heart Disease B29 118 — — 3 7 108 Cerebrovascular Disease B30 256 — — 6 32 218 Other Diseases of Circulatory System B46(6) 103 — — 1 8 94 Influenza B31 13 — — 2 2 9 Pneumonia B32 164 6 — 5 9 144 Bronchitis and Emphysema B33(l) 100 — — — 24 76 Asthma B33(2) 8 — — 2 2 4 Other Diseases of Respiratory System B46(7) 14 1 1 1 4 7 Peptic Ulcer B34 18 — — 1 11 6 Appendicitis B35 2 — — 1 — 1 Intestinal Obstruction and Hernia B36 13 — — — 2 11 Cirrhosis of Liver B37 20 — — 2 11 7 Other Diseases of Digestive System B46(8) 29 — — 1 5 23 Nephritis and Nephrosis B38 7 — — 2 1 4 Other Diseases, Genito-Urinary System B46(9) 25 1 1 2 2 19 Abortion B40 1 — — 1 — — Diseases of Skin, Subcutaneous Tissue B46(10) 2 — — — — 2 Diseases of Musculoskeletal System B46(11) 7 — — — — 7 Congenital Anomalies B42 22 12 — 7 3 — Birth Injury, Difficult Labour,etc. B43 18 18 — — — •— Other Causes of Perinatal Mortality B44 8 8 — — — — Symptoms and I11 Defined Conditions B45 12 — — 1 1 10 Motor Vehicle Accidents BE47 32 — 1 18 5 8 All Other Accidents BE48 47 2 3 13 17 12 Suicide and Selfinflicted Injuries BE49 62 — — 35 15 12 All Other External Causes BE50 14 — — 8 5 1 TOTAL ALL CAUSES 2,155 54 6 167 467 1,461 14 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 1970 166 INFECTIOUS DISEASE The total number of notifications received during 1970 was 576 in comparison with 466 in 1969. Notifications The following Tables show (1) the number of cases of infectious disease notified during the year 1970, 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 1970 1969 1968 1967 1966 Dysentery 18 11 14 11 30 Encephalitis - - 1 - - Enteric Fever - 4 1 1 - Erysipelas - 1 1 3 4 Food Poisoning 48 53 18 12 20 Infective Jaundice 108 77 41 NOT NOTIFIABLE Malaria 4 5 2 4 1 Measles 254 211 296 847 515 Meningococcal Infection - 4 1 2 3 Ophthalmia Neonatorum 2 2 - - 2 Poliomyelitis: Paralytic 1 - - - • Scarlet Fever 22 7 34 15 18 Tuberculosis (all forms) 88 79 101 77 97 Whooping Cough 31 12 46 78 69 TOTALS 576 466 556 1050 759 NOTE: Cases of mistaken diagnosis are excluded from the above Table 15 TABLE 2 Notifiable disease Number of cases notified in 1970 (Age groups in years) Age unknown Under 1 1-2 3-4 5-9 10-14 15-24 25 and over Dysentery — 2 1 2 3 1 4 5 Food Poisoning — 4 6 5 3 — 15 15 Infective Jaundice — — — 3 14 10 36 45 Malaria — — — — — — 1 3 Measles 1 16 65 69 88 6 4 5 Ophthalmia Neonatorum — 2 — — — — — — Poliomyelitis — — — —- — — — 1 Scarlet Fever 1 1 4 4 7 2 — 3 Tuberculosis (All forms) — 1 — 1 7 — 16 63 Whooping Cough — 5 10 4 12 — — — TOTALS 2 31 86 88 134 19 76 140 16 Disease Total cases notified in each Ward in 1970 TABLE 3 St. Charles Golborne Norland Pembridge Holland Earl's Court Queen's Gate Redcliffe Brampton North Stanley South Stanley Church Cheyne Hans Town Royal Hospital Dysentery 2 4 — 1 1 2 1 2 3 — — 2 — — — Food Poisoning 2 2 4 — 4 8 3 6 3 3 5 — 1 1 4 Infective Jaundice 16 14 11 16 8 14 5 11 3 3 — 1 — 3 3 Malaria — — — — — 2 — — — — 2 — — — — Measles 65 36 21 12 11 4 2 19 10 5 31 12 8 5 13 Ophthalmia Neonatorum 1 — — — — — — — — 1 — — — — — Poliomyelitis — — — — — 1 — — — — — — — — — Scarlet Fever 4 8 1 3 — 2 1 — — 2 — 1 — — — Tuberculosis (all forms) 12 9 4 15 7 10 4 5 6 4 4 3 1 2 2 Whooping Cough 8 8 5 2 2 — 2 — 1 — 3 — — — — TOTALS 110 81 46 51 33 43 18 43 26 18 45 19 10 11 22 17 Diphtheria For the ninth consecutive year no case of this disease was notified in the borough. Dysentery Eighteen cases of dysentery were notified during the year of which one case was classified as amoebic dysentery,, one case as Sh.flexner, and the remainder Sh.sonne. Generally the cases were of a mild type and there were no deaths. Malaria Four cases of malaria were reported during the year and investigations indicated that the illnesses were contracted abroad. Food Poisoning Forty-eight cases of food poisoning were notified. The following table gives an analysis of the cases:- Salmonella enteritidis 5 Salmonelia typhimurium 16 Salmonella St. Paul 1 Unknown Salmonella 22 Salmonella Stanley 1 Salmonella Bredeny 1 Salmonella Newport 1 Salmonella Indiana 1 Poliomyelitis One case was notified this year, the first since 1963. The patient was never in the borough as such as he was normally resident abroad, and was taken direct from the airport to the hospital on his return to this country from Africa, Ophthalmia Neonatorum Two cases of this disease 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 93 members of the staff of the department were vaccinated or revaccinated. Information was received during the year from port authorities of 207 persons intending to stay in the borough and who could not produce valid certificates of vaccination after leaving countries which were declared local infected endemic areas. Of these 104 were kept under observation for the surveillance period and remained quite well and 18 were found to have moved to other areas of which the Medical Officers of Health were notified. The remaining 85 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. 18 Tuberculosis During the year 88 new cases of tuberculosis were notified, of which 77 were respiratory and 11 were non-respiratory and 14 other cases of persons moving into this borough were reported, mainly by other borough councils. In addition to the 88 new cases on the register, there were those who were removed from the register because they had moved out of the borough, died, been cured or moved 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 396 203 26 50 675 Every effort has been made by health visitors to visit all newly notified cases (and those transferred in or changing address in the borough) with the object of tracing the source, preventing the spread, and removing 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 Eire - - - - - - 1 - - - 1 Other European - 1 3 2 - - - - - - 6 Fiji - 1 - - - - - - - - 1 Hong Kong - - - 1 - 1 - - 1 - 2 Indonesia - - 1 - - - - - - - 1 India 1 - - - - - - - - - 1 Morocco 1 - - - - - - - - - 1 Pakistan - 1 - - - - - - - - 1 Peru - - 1 - - - - - - - 1 W. Indies - - - 1 - - - - 1 - 2 TOTAL 2 3 5 - - 1 1 - 1 - 17 19 Since 1952, investigations have shown that, of the new cases and "inward transfers" reported in the borough, the proportions who were immigrants contracting the disease in the first ten years of arrival were as follows Year Proportion per cent 1952 16 1953 10 1954 16 1955 17 1956 15 1957 16 1958 23 1959 20 1960 20 1961 11 1962 20 1963 27 1964 23 1965 19 1966 15 1967 21 1968 27 1969 12 1970 16 This year, twelve per cent (1969-thirty per cent) of the infected immigrants were notified within one year of arrival in this country. Fifty nine per cent (1969 - fifty per cent) contracted within three years of arrivals 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, 11,882 of these certificates were authenticated. In addition, 9 special certificates were issued to travellers who refused vaccination on medical or religious grounds. Section 2 PERSONAL HEALTH SERVICES 21 CARE OF MOTHERS AND YOUNG CHILDREN In this section of the report comparative-figures for 1969 are shown in brackets. Maternity and Child Health There were 2,582 notified births, 104 fewer than in 1969, and of these 2,517, or 97.4 per cent, were institutional confinements. The following details of attendances at child health centres reflect the decline in births. Ante-natal and post-natal clinics: Total number of sessions 368 ( 495) Total attendances 2,885 (3,280) Number of women attending during year: Ante-natal 741 ( 799) Post-natal 21 ( 21) Child welfare clinics: Total number of sessions (infant welfare and toddlers) 1,267 ( 1,3^9) Total attendances 19,633 (22,395) Number of children attending during year Born in current year 1,748 ( 1,826) Born in preceding five years 3.056 ( 3,42l) Total attendances at special toddlers clinics 1,759 ( 2,293) Total attendances at child health sessions (infant welfare and toddlers) have fallen by 2,762 from the 1969 figures but against this must be set the increasing number of children who now attend clinics held in doctors' surgeries. DAY CARE OF CHILDREN Council Day Nurseries No changes occurred during the year in the places provided at five Council day nurseries, although it was necessary for a 17 week period during the year to close one nursery partially due to staff shortages. Despite this, the average daily attendance throughout the year has been maintained at a consistently high level and shows only a slight fall compared with the previous years. Approved places 312 ( 312) Total of "weighted registers" 347 ( 347) Total daily attendances 64,186 (66,843) Average daily attendances 255 ( 263) Number on waiting list at end of year Priority 1 and 2 27 ( 38) Priority 3 7 (2) Nursery Nursing Staff The five day nurseries, all of which are approved for nursery nurse training purposes, have a staff of 59 trained nurses and 33 students an increase of 6 students replacing 2 trained nurses. Of the 17 students taking the examination in 1970, 14 were successful in obtaining their certificates. The general staffing situation, with the exception of Kensal House Day Nursery, was satisfactory. 22 Occasional Creches The number of weekly occasional creche sessions provided at 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 seven during the year to a total of 34. The total number of sessions held during the year was 1,440 and total attendances 17,880 compared with 1,279 and 17,746 respectively in 1969. Private Day Nurseries, Child-Minders and Play Groups Another year of implementation of Section 60 of the Health Services and Public Health Act (1968) (which amended certain provisions of the Nurseries and Child-Minders Regulation Act 1948) has now been experienced, and the following table shows the continuing increase in the provision made for day care in the private sector. Number of registered Day Nurseries at 31st December 46 ( 4l) Number of places 1,160 (l,005) Number of child-minders registered at 31st December 108 ( 72) Number of children authorised 257 ( 182) During the year there were numerous individual enquiries, all of which needed visiting, although not all were subsequently found suitable for registration. Supervision was maintained and advice and support given to those providing regular day care. Subsidised child-minder scheme This scheme, approved by the Council as a result of proposals contained in the Department of Health and Social Security Circular 37/68, has been continued. The Council pays the day care charge for children who are placed with registered child-minders, up to 15s (75p) per day, for those in the priority care groups. Parents contribute towards this charge on the same basis as if the children were accommodated in a Council day nursery. At the end of the year there were 7 children placed under this scheme, six with child-minders, one in a private day nursery. Adoption and Boarding-Out of Children Adoption Persons proposing to adopt children are required to submit medical certificates as to their health before a child is placed with them. These certificates are verified by the Council's medical officers before consent is given. Similarly, the medical records of the children to be adopted are scrutinised 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. 23 Boarding-Out The medical examination is given in accordance with the BoardingOut 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: Adoption Cases Children suitable for adoption 14 Children unsuitable for adoption — Couples suitable to adopt children 15 Couples unsuitable to adopt children — Boarding-Out Cases Children suitable for boarding-out 18 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 was 690. The following is a summary of 124 handicapped children on the register: Total No. of children with Handicaps (classified under major handicap) = 124. Mental Retardation 24 Congenital Heart Disease and Cardiac murmurs 23 Talipes and other Orthopaedic defects 17 Spina Bifida, Meningocele and Hydrocephalus 9 Epilepsy 6 Downs Syndrome (Mongolism) 5 Cleft lip and/or cleft palate 5 Cerebral palsy 4 . Hemiplegia 3 Coeliac disease 3 Sickle cell anaemia and Thalassaemia 3 Speech Defects 3 Asthma 3 Blind partially sighted 2 Achondroplasia 2 Deafness 2 Phenylketonuria 1 Cystic Fibrosis of pancreas 1 24 Infantile Autism 1 Grecian nose dwarfism 1 Pierre Rabin syndrome 1 Others 5 124 Notification of Congenital Malformations In 1963, the Chief Medical Officer of the Ministry of Health indicated the intention to enumerate for statistical and epidemiological purposes, all congenital malformations apparent at birth and Medical Officers of Health were asked to arrange a scheme for reporting such abnormalities to the General Register Office, Information about the new-born child would come from the doctor or midwife present at the birth who would be responsible under Section 203 of the Public Health Act 1936 for notification of the birth to the Medical Officer of Health. It was decided that information about congenital malformations could be given on an amended form of birth notification. Commencing on 1st January, 1964, all congenital abnormalities noted at birth in both live and stillborn children were notified to the Medical Officer of Health who completed a standard form for each child for onward transmission to the General Register Office. When this Council assumed responsibility for the personal health services in April 1965„ the scheme was in operation and has continued. Notifications of congenital malformation are received in the health department, recorded and then scrutinised by a medical officer. In some cases the information given may be ambiguous or incomplete. Further information may be sought from hospitals or health visitors so that the defect can be more narrowly defined and more accurately placed on the classification form, A separate form is then completed for each child giving only an identification number and basic information and the abnormality is indicated on a coded list. Table 1-Numbers of children with congenital malformations noted at birth over the past six years. 1965 1966 1967 1968 1969 1970 Total Total Notified Births(1) 3737 3454 3188 2928 2686 2547 18540 Children with congenital defects 64 80 56 41 59 48 348 Stillbirths included in (1) 2 6 4 2 8 3 25 Children with more than one defect 5 18 8 9 13 11 64 Total No, of malformations reported 70 103 66 49 70 63 421 Children with defects per 1000 live and stillbirths 1.7 2.3 1.8 1.4 2.2 1.9 1.9 25 Table 2-Incidence of the commoner malformations which account for 61% of the total observed. Malformation No. of Children affected Incidence per 1,000 live and stillbirths Talipes 92 4.4 Extra digits 36 1.9 Spina Bifida & Meningomyelocele 23 1.2 Cleft Lip and/or Cleft Palate 18 1.0 Cardiac Defects 18 1.0 Hypospadias and Epispadias 18 1.0 Hydrocephaly 15 0.8 Congen. Dislocation of Hip 15 0.8 Down's Syndrome (Mongolism) 12 0.6 Anencephaly 10 0.5 Cervical Cytology Regular fortnightly sessions were held during the year at the South Kensington,, Holland Street and St. Quintin Health Centres, There were 593 attendances at 72 sessions and two positive smears were recorded. Since 1967 the Council has accepted financial responsibility for the screening service provided at a well woman clinic at the Royal Marsden Hospital. During 1970, 370 residents attended this clinic and 3 positive smears resulted. The number of women availing themselves of this service voluntarily can only be described as disappointing. A much larger number of women,, but mostly of child bearing age , are having smears taken when they attend hospital obstetrical or gynaecological departments and family planning clinics. The majority of these are under 35 and not in the 'at risk' group and it is clear that future effort will need to be directed at women over 35 who are particularly at risk and many of whom seem not to be influenced, or perhaps even reached,, by methods of health education used so far. 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,, including two Council Health Centres. which are used by the Association free of charge. The Council have implemented the provisions of the National Health Service (Family Planning) Act, 1967. and the service is available at clinics in the borough 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 1970, the Council met the cost of family planning for 3.765 (3.197) residents. 26 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. 2199 12,151 582 916 Kensington Clinic. 9, Holland Street. 270 1,559 50 100 Chelsea Clinic, Violet Melchett Health Centre. 154 836 52 52 Chelsea Clinic St. Stephens Hospital 853 4,597 145 292 St. Charles Hospital 151 635 51 51 TOTALS 3,627 19,778 880 1,411 The arrangement for women delivered in St. Mary's (Harrow Road) Hospital to be introduced to family planning whilst still in hospital and given initial help at the adjacent Westminster City clinic continues. 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 grant aid to the London Diocesan Council for Moral Welfare and the Crusade of Rescue (Westminster Catholic Moral Welfare Association) in 1970. Information is now available of mothers who contacted moral welfare associations as follows:- 1968 1969 London Diocesan Council 111 75 Crusade of Rescue 108 80 Southwark Catholic Childrens Society - 1 Norwood Joint Committee 3 2 222 158 27 1968 1969 Age under 15 Nil Nil 15 - 19 36 33 20 - 24 121 85 25 - 29 50 30 30 - 34 11 4 35+ 45 unknown - 1 222 158 Marriage Guidance Grants were again made by the Council to the under-mentioned organisations in respect of their work with residents of the borough during the years:- London Marriage Guidance Council £700 Catholic Marriage Guidance Council £425 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 Over the year the domiciliary midwives have increasingly worked within the community nursing team, and in so doing have taken part in health teaching and student programmes. Except for the area in the North of the Borough covered by Queen Charlotte's Hospital Domiciliary Service, all domiciliary midwifery is undertaken by the midwives employed by the Council. The demand for domiciliary confinements continues to fall. Only 52 such confinements were attended compared with 73 in the previous year. The number of planned early discharge cases has increased to 214 but if the Borough is to continue to provide domiciliary experience for pupil midwives taking their Part II training it is hoped that hospitals will encourage early discharges in suitable cases wherever possible. In addition,, the midwives have attended 44 mothers in the General Practitioner Unit at St. Mary Abbots Hospital. These mothers are medically and obstetrically normal but, for varying reasons, cannot conveniently be delivered in their homes. The following is a summary of midwifery services: 1. Domiciliary Deliveries Cases booked Cases not booked with a doctor with a doctor attended by : Council's midwives 38 (57) 3 (2) Hospital midwives 10 (13) 1 (l) TOTAL 48 (70) 4 (3) 28 2. Early Discharges Planned. Not planned nursed by: Council's midwives 107 (108) 92 (57) Kensington D.N.A. - ( 22) - (4) Hospital midwives 12 ( 10) 3 (3) 119 (140) 95 (64) 3. General Practitioner Maternity Unit Confinements attended by Council midwives 44 (40) Number in which doctor was present 42 (38) Training of Pupil Midwives Eight pupil midwives completed their Part II training in the Borough and all were successful in their examinations. Refresher Courses One domiciliary midwife attended a refresher course as required under Central Midwives Board Rules. Midwives Act. 1951 The Council are the local supervising authority for the purposes of the Midwives Act, 1951, and have a duty to inspect and supervise all midwives practising in the area, details follow:- Notifications received from midwives of intention to practice 90 (107) Refresher courses attended by midwives in accordance with Section 9 of the rules of the Central Midwives Board 11 ( 10) HEALTH VISITING Previous Annual Reports have emphasised the attraction which the Borough provides to health visitors of a high calibre, because of the great variety of experience which is to be gained from its wide cross section of social groups. Once again I am pleased to report that the staffing position has been maintained. The scope of the work of the health visitor demands the widest use of those skills she has gained not only during the health visitor training course, but also developed during her earlier state registration training in hospital, and her subsequent midwifery training. These professional qualifications prepare her for her work with all ages within the community, the antenatal mother, the young child, the adolescent, the handicapped to the elderly. One of her most important roles is in teaching the basis of healthy living, and in this she undertakes teaching wherever possible within the home, school, clinic, club or in response to any invitation from voluntary groups. A list demonstrating this wide range of health education activities which are undertaken, is to be found under Health Education elsewhere in this report. 29 The 1969 report referred to research undertaken on behalf of the London Boroughs Training Committee by the Greater London Council's Research and Intelligence Unit. In this 8 Health Visitors in the Borough co-operated. The publication of this report has been delayed but preliminary findings indicate that the work of Health Visitors in a central London borough is complicated by the mobility of population, the difficulties of travel, and the high cost of living. The following table records details of visits by Health Visitors during the year. First visits to:- Children born 1970 2,397 ( 2,333) Children born 1969 1,900 ( 2,122) Children born 1965/68 3,181 ( 4,149) Persons aged 65 or over 353 ( 298) Mentally disordered persons 84 ( 57) Persons discharged from hospitals (excluding mental) 88 ( 83) Tuberculous households 177 ( 124) Infectious households 56 ( 6) All other cases 1,146 ( 1,449) Total cases visited 9,382 (10,621) Total effective visits and revisits 25,935 (29,816) Unsuccessful visits 8,188 ( 9,697) Health Visitor Students Eight students were sponsored for health visitor training and training facilities for practical work with a Fieldwork Instructor were again given to health visitor students from the Royal College of Nursing, the North Western Polytechnic, Chiswick Polytechnic and the University of Surrey. Co-operation with General Practitioners The attachment of community nursing staff to general practitioners has continued to develop slowly. This includes in many practices a team including health visitor, domiciliary midwife and district nurse. Attachment and liaison schemes now involve 8 group practices with a total of 20 doctors and a total of 16 community nursing staff. This method of working has been found advantageous by both the doctors and the community nursing staff, and it is to be hoped that, as more general practitioners work within group practices, this method will be further developed. Co-operation with Hospitals Health visitors continue to teach in the Schools of Nursing at St. Charles's and St. Stephen's Hospitals, on the community aspects of health and disease and the preventive and social care available for families within the community. 30 In order to bring about a greater understanding of the continuing care of the patient within the community,, the Principal Nursing Officer initiated a study day for nursing staff of both the Chelsea and Kensington Group of Hospitals and the community nursing staff. This day was most successful and is to be repeated in the Spring. Schemes for closer liaison between hospital and community nursing staff have been developed at the following hospitals: Princess Louise Hospital - Paediatric Liaison St, Charles' Hospital - Paediatric Liaison St, Mary's Paddington - Teaching and Maternity Department St, Stephen's Hospital - Teaching and Maternity Department St. Luke's Hospital - Geriatric Liaison An extremely useful scheme of liaison between the health visitors and the psychiatrist and psychiatric social worker of the local child guidance clinic has been maintained at one health centre on an informal basis. Both groups have benefited from this opportunity of discussing the problems they have in common. Health Visiting with the Elderly The development of attachment schemes in group practice bring health visitors in touch with increasing numbers of elderly people. Visiting to the elderly in their homes has increased, and has led to the formation of special clubs for them at all health centres. The club activities cover films, talks and discussions on a wide range of health and social topics. Reference has been made earlier to developing liaison with the geriatric hospital services. This extension of the service is important and will prove of great benefit. In-Service Training A number of talks were arranged for the nursing staff. These included:- "Housing in the Borough" by Dr. J.H. Weir, Medical Officer of Health. "The Work of the Chest Clinic" by Dr. E.E. Keal, Consultant Chest Physician. "Recent Developments in the Child Care Service" by Mr. D.J. Stapleton, Deputy Children's Officer. "Arming Me from Fear" - film produced by Milton Ltd. "The Education Welfare Service" by Miss C.Y. Jefferis, Divisional Education Welfare Officer. "The Work and Problems of the Mental Welfare Officer" by Mr. K. Chambers, Principal Mental Welfare Officer. "The Work and Problems of the Public Health Inspector" by Mr. D.C. Draper, Chief Public Health Inspector. - 31 - Nursing officers acted as lecturers at courses which included the following:- (a) Health Visitors Association - Course for Parents of Mentally Handicapped Children. (b) Marlborough Teachers Centre - "The Work of the Health Visitor in the School and Community.M (c) Bedford College Post-Graduate Studies Students Seminar. (d) St. Marys Hospital School of Midwifery - "Domiciliary Midwifery". (e) G.L.C. Ambulance personnel - "Emergency Midwifery". The Principal Nursing Officer accepted an invitation to present a Paper to the Royal Society of Health Congress at Eastbourne in April on "The Working Mother; the Effects Upon the Home and Family", which received considerable press and television publicity. Students and Visitors Once again we were pleased to welcome many overseas visitors including:- Two Professors from the U.S.A. - one a Research Professor on a World Health Organisation Scholarship. The wife of the Prime Minister of Sweden (Mrs. L. Palme) A Public Health Nursing Officer from Denmark studying on a Council of Europe Fellowship. Visits of observation to day nurseries and health centres were made by the following groups:- 138 student nurses from St. Stephen's and St. Charles's Hospitals 20 student nurses from St. Mary Abbots Hospital 20 students from the North Western Polytechnic taking the course in residential child care. 40 student teachers from the Froebel Institute. 11 student dieticians from the Queen Elizabeth College. 9 pupil midwives. 60 nursery students. 27 pupils from local schools. 4 social work students from Croydon Technical College. 1 child care student. 4 general practitioners. 4 student teachers from the Maria Assumpta College. 3 student teachers from Southlands College, Wimbledon. Arrangements were made for 6 pupils from Ladbroke Senior Girls School to work voluntarily for one half-day a week during the school term at 3 separate day nurseries. 32 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 consists of the superintendent (Miss E.M, Evans, S.R.N. ,S.C.M.M.T.D.) and one assistant superintendent. The following is a summary of the service for the year:- 1. Staff State registered and state enrolled nurses 43 Total full-time equivalent 4l Students 5 2. Number of patients attended by nurses: 0-4 25 5-64 681 65+ 1,687 Total all ages 2,393 (2,643) 3. Number of new cases: Medical 1,396 Surgical 258 Tuberculosis 11 Maternity 6 Mental ill health 17 1,688 (1,876) 4. Visits paid by district nurses for: Injections only 17,483 Injections plus other treatment 2,100 Other treatment only 70,147 89,730 (90,020) 5. Nursing treatments: Number of patients attended for at least 3 months 174 ( 225) Number of completed treatments 1,808 (2,085) Number of patients being attended at end of year 719 ( 703) Average number of visits per patient 37 ( 34) The overall number of patients has shown a tendency to decrease since 1965. This has occurred in the age groups up to age 64 with the result that the proportion of elderly patients has increased. The average number of visits per patient during 1970 was the highest for the past six years. Little Sisters of the Assumption A grant of £200 was made to the Little Sisters of the Assumption in respect of the domiciliary nursing service provided by the Order. 33 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 £125 towards this work. The demand for all types of equipment has increased as indicated by the 633 issues made by the Council, and 826 by the British Red Cross Society, as compared with 388 and 706 respectively during 1969. The demand for incontinence pads has again increased somewhat, 232 patients having been served compared with 219 in 1969. Adaptations for installations of Artificial Kidney Machines One application was received during 1970 for works of adaptations to the home of a patient accepted for chronic intermittent haemodialysis . The patient was resident in the borough but was in the process of purchasing another property. Such were the considerable works of improvement and repair necessary to this property that the works of adaptation for the installation of an artificial kidney machine formed only 10 per cent of the total building work. For this reason, although authority for the adaptation work for this purpose had been given during June, by the end of the year the building work, which was expected to take 6 months had only just commenced and there was no prospect of early installation of the dialysis equipment. Again it must be recorded that the cost of works of adaptation were high and in this instance were estimated at £520. This was partly attributable to the fact that the adaptations were to an older property and included strengthening of the floor structure to receive the weight of dialysis equipment. 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-five were issued during 1970, compared with 39 in 1969. 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 hones. HOME HELP SERVICE The demand for this service increased and was 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 who comprised 85$ of all households assisted compared with 81% in 1969. 34 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. Two such cases occured during 1970. compared with three in 1969• The following is a brief summary of the service. Number of households assisted 1,655 (1,607) Number of new applications received 707 ( 633) Details of households assisted:- Maternity 22 ( 25) Tuberculosis 8 ( 8) Old People 1,361 (1,304) Chronic sick 122 ( 124) Early morning and evening help 5 ( 9) Special help (problem families) 8 ( 2) Mental disorders 4 ( 7) Miscellaneous 125 ( 128) Staff details:- Number of home helps employed at end of year 131 ( 126) Equivalent of whole-time staff 102.8 (112.9) IMMUNISATION AND VACCINATION The modified programme for vaccination and immunisation against various diseases which was introduced in 1968 had a marked effect in that and the following year. By 1970, the scheme had settled into the new pattern, and despite the continued decrease in the number of births, slight increases have occurred in the number of primary courses against diphtheria, whooping cough, tetanus and measles. There has also been a considerable increase in smallpox re-vaccinations mainly in respect of children approaching school-leaving age most of whom were treated by their general practitioners as a result of requirements for travel abroad. The number of children protected against poliomyelitis has fallen slightly, but the acceptance rate is higher than for any other immunisation procedure. This is probably due to the fact that this vaccine is now almost exclusively given by the oral (Sabin) method. Although the noted increases are encouraging, the acceptance rate for all the afore-mentioned protective measures is still unsatisfactorily low. A summary of immunisations is given below: Primary courses completed Reinforcing doses Poliomyelitis vaccination (No Salk vaccine was, used) at Council clinics: Sabin 1.593 (1.634) 1,613 (1,626) by general practitioners: Sabin 319 ( 336) 243 ( 237) TOTAL 1,912 (1,971) 1,856 (1,863) 35  Primary courses completed Reinforcing doses Diphtheria Immunisation at Council clinics 1,350 (1,344) 1,301 (2,274) by general practitioners 334 ( 284 254 ( 407) 1,684 (1,628) 1,555 (2,681) Whooping Cough Immunisation at Council clinics 1,046 (1,018) 174 (765) by general practitioners 270 ( 254) 73 (222) 1,316 (1,272) 247 (987) Tetanus Immunisation at Council clinics 1.358 (1,345) 1,443 (2,280) by general practitioners 351 ( 293) 264 ( 425) 1,709 (1,638) 1,707 (2,705) Measles Vaccination at Council clinics 952 ( 854) - by general practitioners 20? ( 243) - Smallpox vaccination 1,159 (1,097) At uouncil clinics By general practitioners Total Primary vaccinations Under 1 year 26 ( 16) 7 ( 18) 33 ( 3*+) 1 year 473 (661) 132 (162) 605 ( 823) 2-4 years 286 (272) 149 ( 83) 435 ( 355) 5-14 years 35 ( 30) 41 ( 36) 76 ( 66) 15 years and over 2 ( 8) 9 ( 7) 11 ( 15) TOTAL Revaccinations 822 (987) 338 (306) 1,160 (1,293) Under 1 year 2 (Nil) Nil ( 1) 2 ( 1) 1 year 5 (Nil) Nil (Nil) 5 (Nil) 2-4 years 14 ( 15) 16 ( 20) 30 ( *35) 5-14 years 42 ( 22) 118 (113) 160 (135) 15 years and over 16 ( 9) 180 ( 21) 196 ( 30) TOTAL 79 (46) 314 (155) 393 (201) 36 Vaccination against Rubella (German Measles) During 1970, the Department of Health and Social Security announced the introduction of vaccination against rubella (German Measles) into local health authority prophylactic programmes with full participation by general medical practitioners. Recent surveys had shown an association between abnormalities found in new-born children and rubella infection of their mothers in early pregnancy. The scheme for vaccination against rubella provides for vaccination of girls between their 11th and 14th birthdays which will give longterm benefits for children of the future rather than conventional population immunity as with other prophylactic measures. For practical purposes vaccination against rubella will be phased so that the first group will consist of the older girls in their fourteenth year. Arrangements have been made for the initial programme to commence during the Spring Term 1971• Publicity was given to this scheme in the local press, by circulation of information to general practitioners and to the parents of eligible school girls„ Tuberculosis (B.C.G. Vaccination) Thirteen year old school children The acceptance rate for this protective measure is still at a satisfactorily high level. The skin test used is Mantoux (10 TU). Early in 1970, it was necessary to arrange for completion of the previous year's programme„ which had been deferred due to a temporary shortage of staff. Some schools were accordingly visited twice during the year, and the apparent increase in the numbers of children dealt with is due to the inclusion of the children who would normally have been dealt with in 1969. Schools visited 9 (4) Number of eligible children 2,876 ( 710) Number of acceptances 2,043 ( 520) Acceptance rate 71.0% (073.2%) Number skin-tested and read 1.322 ( 382) Number given BCG vaccination 1.209 ( 343) Number of positive reactors 113 ( 39) Positivity rate 8.6% (10.2%) Contacts The numbers of contacts of cases of tuberculosis dealt with at chest clinics continue to decrease, being 20% below the 1969 level. The positivity rate in this group was 17.35 compared with 37.5% in 1969. Number skin-tested and read 104 (130) Number found negative 86 (81) Number given BCG vaccination 86 (79) Number found positive 18 ( 49) 37 Mass Radiography Following receipt of Department of Health and Social Security circular 1HM(69)97, hospital authorities reviewed the effectiveness of the Mass Miniature Radiography Service and considered how the need for chest x-ray services could best be met on the basis of an integration within hospital radiological departments of mass miniature radiography units. The South West and North West Metropolitan Regional Hospital Boards prepared proposals for implementing the Department's requirements but in neither case was any immediate withdrawal of mobile units planned,. It was envisaged, however, that they would provide only a restricted screening service and a facility for special epidemiological investigations„ Sessions held solely for general public volunteers would be discontinued,. From the point of view of the local health authority the mobile mass miniature radiography service is of immense value not only in screening large numbers of the public but also individual communities, e.g., schools, business firms, staff of childrens homes/nurseries, etc. To a large extent this latter group will be catered for in the revised programmes, but it is a cause for concern that in the long term the general public may well be deterred from seeking this service by the travelling, waiting and general inconvenience of a hospital visito The mass radiography service is true preventive medicine, being concerned in the main with ascertaining that people have healthy chestso It is also concerned with positive findings, and here this is not only to the advantage of the individual, it is also of advantage to the community as it enables preventive measures to be taken. On a cost/benefit basis mass radiography is no less rewarding than many other elaborate and expensive screening procedures currently being undertaken, e.g., Guthrie tests, cervical cytology. It is noted from a recent mass radiography unit annual report that of the total number of active cases of tuberculosis detected, no less than 54 per cent were either individual volunteers or in organised groups. It was further noted that at one central London mass x-ray centre approximately 46 per cent of active cases detected were not British born. Any restrictions in the availability of preventive health measures must be viewed with concern. It is to be hoped therefore that in formulating final plans for the future of the mass x-ray service due regard will be had to the special needs of this borough where a high proportion of multi-occupied accommodation with a mixed and highly mobile population creates a greater risk of spread of infection. PREVENTION OF ILLNESS. CARS AND AFTER-CARE Chiropody The new two-chair clinic at the Violet Melchett Centre, Flood Walk, S.W.3., was opened in April. Local demand and an improvement in staff recruitment soon enabled it to reach its peak operation of 20 sessions weekly, although this could not unfortunately be maintained throughout the year, the average being nearly 18. Many of the clients who came to this clinic used to attend the voluntarily-managed clinic which was staffed from the Chelsea School of Chiropotfy at the Community Centre, 385, Kings Road and closed early in the year. - 38 - Arrangements for weekly transport of up to 12 selected patients to the Chelsea School of Chiropody, Samford Street, N.W.8., continued until November. Thereafter their treatment continued either by domiciliary visits or attendance at nearby Council clinics, with the use of voluntary transport as necessary. Details of attendance, etc., are as follows Total number of sessions held at Council clinics 2,380 (1,527) Number of persons attending Council clinics 2,864 (2,307) Analysis by age-groups of attendances at Council clinics Children - Under 5 1 ( nil) 5-14 years 153 ( 92) Expectant mothers 1 ( nil) Males - 15 to 64 years 1,168 ( 995) 65 years and over 1,684 ( 1,308) Females - 15 to 59 years 3.537 ( 3.037) 60 years and over 7.996 ( 6,256) Total attendance at Council clinics 14,540 (11,688) Number of patients referred to private chiropodist 48 ( 59) Number of treatments given by private chiropodist 1,018 ( 747) Recuperative Holidays The report for 1969. commented on the decline in the number of recuperative holidays for persons classified as "other adults" who are mainly elderly persons. The decline in the number of holidays provided has continued into 1970, not only for this, but for all groups. All these groups show high proportions of abortive applications, as the following details show:- Number of applications Number of admission Number awaiting placement at end of year Expectant and Nursing Mothers 18 ( 17) 9 (11) Nil (l) Other Adults 148 (118) 70 (74) 7 (2) Children under 5 29 ( 37) 12 (22) Nil (3) Schoolchildren 47 ( 5*0 29 (37) 9 (3) Health Education Again a very extensive and diverse programme of health education activities has taken place. This is a continuing process for field workers, in the main health visitors, who as part of their day to day duties come into contact with the public either individually or in group situations. The public health inspectors are also concerned with certain aspects of health education as a regular part of their routine duties. 39 A phased programme of key subjects was determined at the beginning of the year and general publicity and displays at health centres followed the following programme: January - Home Safety and Hypothermia February - March - Prophylaxis April - May - Safety for under 3s June - July - Food Hygiene and Hygiene in the Home August - Health visitors chose theme relevant to their centre. September - October - Dental Health November - December - Home Safety During June a display stall featuring the subject Food Hygiene was positioned in Kings Road and then in Portobello Road. Additionally the National Dairy Council sponsored a National Milk Publicity Campaign during June with displays at the Central and Chelsea Libraries. During November Messrs. Heinz & Co. Ltd., arranged demonstrations of nutritious foods at various health centres. Health Centre Clubs Clubs for the elderly and for mothers are organised by health visitors at a number of health centres. They provide the opportunity to introduce health education topics in a varied programme of activities as indicated by the following summary: 1. Location of clubs (a) for the elderly St. Quintin Raymede Kensal Lancaster Road (b) Mothers Clubs Raymede Lancaster Road I Kensal South Kensington Violet Melchett Walmer Road 2. Activities (a) Speakers The following organisations were represented by speakers who addressed the club meetings: Consumer Council Eye Care Bureau Citizens Advice Bureau British Red Cross Society Cecil Homes for the Elderly Clarks Shoes Ltd. Other Council Departments. i.e., Children's Department. 40 (b) Practical The following special activities were arranged: Cookery Classes Keep Fit Classes Sewing Classes Exercises for the elderly (c) Visual Suitable films were shown frequently Health Education in Schools An established pattern of health education periods in four schools in the Borough continued in 1970 and was extended into a further four schools as indicated: Ladbroke Upper School St. Thomas More St. Francis Junior Holland Park Comprehensive Christ Church Junior School Isaac Newton Colville Infants Sion Manning The St. Nicholas Montessori Training Centre 2 Health Visitors 2 Health Visitors 1 Health Visitor 1 Health Visitor 2 School Nurses 1 Health Visitor 1 School Nurse 1 School Nurse 1 Health Visitor 2 Health Visitors 4th year and 6th year girls. 4th year and 6th year girls. 10 - 11 year old girls. Selected groups of 1st year to 6th year. 10 year olds. Selected groups of senior boys. Selected mixed groups. Selected groups of senior girls. Series of lectures on Mothercraft and child development. The subjects covered were suited to the age groups of pupils and wide ranging as the following summary shows: Parentcraft Child care and development Home nursing First aid Care of the elderly Nutrition Obesity Care of the feet, hair, skin and eyes Cancer education Mental Health Home safety Drug dependence Venereal diseases Alcoholism Dangers of smoking Family planning Physical handicap Dental health 41 Other Health Education Activities 1. Hospitals Health visitors gave talks to mothers awaiting discharge from Sto Stephen's Hospital and St. Mary's Hospital, W.2., on care of their babies and how to contact their health visitors and other family health subjects,, 2» Talks to Groups Health visitors gave talks to other groups including the Adventure Playground Youth Club (Drugs, V.D.). The Greater London Conference on Old People's Welfare (Health in old age), Women's Club (American) (Needs of the elderly)„ 3o Psychoprophylaxis Psychoprophylaxis classes were held at the Holland Street, Walmer Road, Lancaster Road, Raymede, South Kensington, Violet Melchett and Kensal Health Centres. 4. Representation on other Organisations A member of the Health Committee and a Nursing Officer represented the Council on the Greater London Home Safety Committee of the Royal Society for the Prevention of Accidents. A Principal Medical Officer represented the Department on the Inner London Education Authority's Health Education Panel. The following details indicate the activities and subjects covered in the Health Education Programme. 1. Speakers Talks Health Visitors 1,209 Midwives l6 I.L.E.A. Instructors 14 School Nurses 34 Other Council Officers 18 Other 160 1,451 SUMMARY - 42 - 2. - Subjects Talks Attendances Care of Mothers and young children 643 5,103 First aid 21 260 Prevention of accidents 47 723 Infectious diseases and prophylaxis 10 213 Family planning 14 188 General Family Health 202 2,937 Role of the Health Visitor 36 488 Care of older children 33 300 Venereal Disease 19 356 Mental Health 2 19 Drug addiction 24 554 Smoking and Lung Cancer 10 138 Social Services 5 82 Other 385 4,280 1,451 15,641 3. Audiences Groups Totals Schoolchildren 364 4,864 Mothers 377 3,537 Expectant Mothers 453 2,719 Over 50s 184 2,901 Student Teachers 21 672 Student nurses 30 451 Playgroup Leaders and child minders 7 70 Youth Groups 5 257 Parents 6 132 Voluntary workers 1 4 Child Care Officers 1 3 General Practitioners 1 1 Other 1 30 1,451 15,641 Public Health Inspectors As already mentioned the public health inspectors take a considerable part in health education. During the normal course of their duties they come into contact with a wide variety of people including shop keepers and food handlers. Every opportunity is taken of advising and instructing staff of the establishments they visit. In addition from time to time requests are received for talks to be given on various health subjects and, wherever possible, on the initiative of public health inspectors owners and proprietors of businesses are invited to arrange for talks to their staff. Subjects range from matters of general interest on the work of the department to organisations such as clubs and discussion groups to more detailed talks on subjects of health and hygiene to specific organisations and specialised groups such as hotel chefs and food handlers in large stores and schools. The officers concerned are always pleased to give such talks at any time. 43 Borough Co-ordinating Committee Three meetings of the Borough Co-ordinating Committee were held during 1970. Subjects discussed included the N.S.P.C.C. Battered BabyStudy, the Local Authority Social Services Act, 1970 and the new Education Welfare Service of the Inner London Education Authority. Projects which might be suitable for inclusion under Phase III of the Urban Programme were put forward and discussed. Thirty case conferences were held during the year, when consideration was given to the problems of 28 (40) families causing concern to statutory and/or voluntary services. Many such families require a high degree of support in order to help their survival as family units and at the end of the year the department's Family Caseworkers were visiting jS families. Close liaison continued with the Family Welfare Association and the West London Family Service Unit. Grants made during the year by the Council totalled £4,015 and £8,615 respectively. Details of their work in respect of families resident in the borough were as follows:- Family Service Unit Family Welfare Association No. of families with whom caseworkers were working No. of children in families No. of families with whom caseworkers were working No. of children in families On 1st January, 1970 57 237 98 174 Added during year 12 39 97 106 Withdrawn during year 22 82 110 77 On 31st December, 1970 47 194 85 203 - 44 - Venereal Diseases - New cases reported during 1970. summarised from the returns made bv the physicians in charge of treatment centres at which residents of the borough were treated. Situation of Clinic Total of all venereal conditions SYPHILIS GONORRHOEA Other venereal conditions Primary and secondary Other 1970 1969 1968 1970 1969 1968 1970 1969 1968 1970 1969 1968 1970 1969 1968 Central Middlesex Hospital 26 * 18 * — * * - 6 * 2 20 * 16 Dreadnought Seamen's Hospital 8 6 3 • - - - 1 - - 1 - 8 4 3 The London Hospital 144 156 137 - - - - 2 1 21 35 33 123 119 103 Middlesex Hospital 1158 1328 1012 6 15 11 9 19 16 219 282 265 1000 1012 723 Moorfields Eye Hospital * 9 4 * - - * - 2 * - - * 9 2 St. Bartholomew's Hospital 200 143 * 5 - * - * * 29 29 * 166 114 * St. George's Hospital** * * * * 41 ♦ * * * * * * * * ♦ St. Mary's Hospital 3264 2454 2258 39 39 39 39 28 30 808 735 511 2378 1652 1678 St. Thomas Hospital 577 586 415 1 7 3 2 1 5 100 112 85 474 466 322 West London Hospital 4613 3475 * 27 16 * 17 23 * 1057 922 * 3512 2514 * Westminster Hospital 344 351 249 2 1 4 - 2 - 52 73 42 290 275 203 * Figures not available. ** In 1957 a total of 854 new cases were treated at this hospital. Although the information is still incomplete it is apparent that the increase in venereal conditions is still continuing. Section 3 SCHOOL HEALTH SERVICE 45 SCHOOL HEALTH SERVICE IN KENSINGTON AND CHELSEA Annual Report by Dr. J.H. Weir, Borough Medical Officer of Health and Principal School Medical Officer The Inner London Education Authority is responsible for the school health service but by virtue of an agreement required by Section 32 of the London Government Act, 1963, there is joint use by the Authority and the 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, 1970. Where relevant, comparable figures relating to the previous year are shown in brackets. At September 1970 there were 9,44l (9,677) pupils attending thirty primary schools and 6,155 (7,5l6) pupils attending 8 (11) secondary schools. In addition, 164 (160) children attended nursery schools and a number of spastic children 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-pluso and finally during the term immediately preceding the end of their school life. During the year 7,046 (7,38l) children were examined in 708 (771) sessions. The total number of defects found was 2,706, representing an incidence of 38$ of the number of inspections. Of these defects 1,205 (or 17%) were noted for treatment. Vision defects comprised 1,024 of the total of which 55^ were noted for treatment. SPECIAL 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 49 (95) statutory examinations were carried out. Referrals included 40 (67) for the statutory E.S.N. examination which resulted in 14 (33) recommendations for education at schools for the educationally sub-normal. The remainder included 9 (15) recommendations for open air schools. Other examinations included 190 (288) secondary school pupils seeking employment and 1,005 (876) wishing to go on school journeys. 46 HANDICAPPED PUPILS There are no special schools for the education of handicapped pupils in the area, but a total of 208 (291) children requiring special educational treatment attended schools in other boroughs and 86 (ill) were placed in boarding schools„ Included in these numbers were 26 (30) physically handicapped children in attendance at day schools and 6 (9) at boarding schools. Attending ordinary schools were 70 (69) epileptic children, 45 (46) with orthopaedic and postural defects, 7 (15) suffering from diabetes, 15 (21) from rheumatism, 213 (145) from asthma, 17 (15) cerebral and spastic cases, and 14 (11) with eye diseases other than refractions and squints. The number of maladjusted children referred to the Problem Case Conference was 153 (150). Of this number, 103 (78) were referred to Child Guidance Clinics There were two tutorial classes for maladjusted children and 15 (10) children were recommended for them from Case Conference, CLINICS Vision Total attendances numbered 2,028 (1,800) at 162 (163) sessions held during the year. New cases attending during the year numbered 838 (1,308). Partially sighted children educated in special schools numbered 8 (ll). Hearing Audiometry During the year 4,177 (3.676) children in ordinary schools were given the "Sweep" test by the nursing sisters. Details of the results are shown in the following table Boys Girls Total Sweep Test Number tested 2225 1952 4177 Number passed 1954 1688 3642 Number failed 271 264 535 Pure Tone Test of Sweep Test Failures Number tested 124 122 246 Number passed 89 83 172 Number failed and referred to otologist 35 39 74 Other Pure Tone Tests (including Hospital care) Number tested 98 75 173 Number passed 56 46 102 Number failed and referred to otologist 42 29 71 47 In addition to 8 (5) children attending schools for the deaf, 6 (8) attended partially hearing units Of the 16 (17) children wearing hearing aids who attended other schools, 11 (9) were in ordinary schools, 1 (2) was in a school for the physically handicapped and 4 (6) were in schools for the educationally sub-normal. Audiology The total attendances at the 40 (43) sessions held numbered 277 (274). New cases attending during the year totalled 84 (83). 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 1, Nose and Throat There were 20 (63) sessions held during the year. Total attendances numbered 100(370). New cases attending during the year numbered 4 (39). 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 111 (114) sessions held, 93 (124) new cases were seen, while the total attendances amounted to 782 (820). Minor Ailments Medical officers conducted 92 (109) sessions and examined 361 (467) new cases. Nursing sisters held 746 (921) sessions and saw 955 (2,576) new cases. Altogether the total attendances at the clinics numbered 6,693 (9,822). Speech Therapy There were 3(3) clinics staffed by 3 (4) speech therapists with 10 (12) sessions a week. PERSONAL HYGIENE Of 15.459 (14,915) children seen during comprehensive surveys 192 (139) were found to be verminous. Inspections during selective surveys numbered 5,717 (6,004) and on 274 (168) occasions children were found to be verminous. The number of individual children found to be verminous was 244 (181). BATHING CENTRE Children attended the bathing centre on 428 (458) occasions, when 78 (134) cases of scabies and 272 (228) 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. 48 REMEDIAL FOOT CLASSES With the continued co-operation of the head teachers, remedial classes were held in eight primary schools and 190 (256) 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) Smallpox 76 ( 66) 160 ( 135) Diphtheria/Tetanus/ Whooping Cough: Triple 17 ( 27) 54 ( 72) Diphtheria tetanus 192 (205) 1,170 (1,534) Diphtheria 2 ( 6) 51 ( 2) Tetanus 22 ( 13) 199 ( 21) Poliomyelitis: Salk Nil (Nil) Nil ( Nil ) Sabin 244 (267) 1.547 (1,564) Measles 72 ( 82) — — B.C.G. VACCINATION FOR 13-YEAR OLD CHILDREN A medical officer, together with a clerical assistant, visited 9 (4) schoolso There were 2,876 (710) children eligible for B.C.G. vaccination. The parents of 2,043 (520) children gave their consent and out of this number 1,322 (382) were skin-tested and read. Of these 1,209 (343) children were vaccinated. The remaining 113 (39) were found to be positive reactors. In 1969 the programme was not completed due to staff shortage, and the figures for 1970 therefore include the back-log so arising. 49 INFECTIOUS ILLNESS The following table shows the number of cases of infectious illness reported from the schools by head teachers during 1970:- Disease Total Disease Total Chicken pox 135 Ophthalmia and conjunctivitis 2 Diphtheria 1 Pneumonia 3 Dysentery) Diarrhoea) Enteritis) 23 Ringworm (Scalp) 11 Ringworm (Body) 4 German Measles 35 Scabies 9 Influenza 9 Scarlet fever 24 Impetigo 7 Tonsillitis 23 Jaundice 19 Whooping Cough 24 Measles 56 Section 4 DENTAL SERVICES 51 THE DENTAL SERVICES STAFF A number of changes of staff took place during the year the most important being the resignation of the Principal Dental Officer, Mr, M.C. Downer, L.D.S.,R.C.S.,D.D.P.H., who obtained a Research Fellowship in Dental Health at the Turner Dental School of Manchester University and left the Council's service on 30th September, 1970. His successor Mr. A. Longden, L.D.S., was appointed in December to take up his duties early in 1971. In the previous report reference was made to vacancies in the professional establishment at the end of 1969. In January, 1970 one part-time dental officer resumed full time employment and three more part-time officers commenced duty in February. One of these three became full time in November, the authorised establishment having been increased from 4 to 4.6 full time equivalent dental officer units , At the end of the year the four dental clinics were accordingly staffed by three full time and two part-time dental officers and running at full capacity except for the four sessions a week allocated to the Principal Dental Officer. The dental officers were supported by four dental surgery assistants, INSPECTION AND TREATMENT OF SCHOOL CHILDREN During the year a total of 18 infant schools and departments, 21 junior schools and departments and 6 senior schools received routine dental inspections. The number of sessions undertaken and the overall number of children inspected during the year show little variation from the 1969 levels. The percentages of inspected children found to require treatment have fallen and this is mainly responsible for the lower numbers of visits for treatment, EVALUATION OF AN UNSUPERVISED PROGRAMME OF ORAL HYGIENE A survey was undertaken in North Kensington Infants School to evaluate the unsupervised use of dental hygiene packs, A number of children selected at random to form study and control groups were initially examined to ascertain the state of oral hygiene and gum condition. This was followed by an intensive dental health education session for the study group children who after a further week were issued with dental hygiene packs; also letters were sent to their parents inviting co-operation. Eight weeks after the first examination a second was performed and the programme was completed after a further week by conducting a brief questionnaire among the study group to obtain information on their oral hygiene practices. The results of observations were analysed statistically and findings of significance led to the following conclusions:- 52 (i) Examinations of the mouth by a dentist appear in themselves to influence dental awareness and improve oral hygiene although there were indications that improvements noted in the control group probably resulted from close daily contact with the study group. (ii) The children in the study group showed a greater improvement than those in the control group in both oral hygiene and condition of gums. this improvement being more marked between older children in the two groups . (iii) Improvements in oral hygiene were more marked than improvements in gum condition. (iv) The improvements in oral hygiene noted in the study group were more marked in the older children than in the group as a whole,, whereas this situation was reversed in the control group. (v) There was no indication that the letters to the parents had any significant effect, the improvements noted apparently resulting largely from the children's own initiative. The results of this study suggest that the issuing of dental packs appears to be a useful preventive measure and for maximum effect should be combined with a dental examination and dental health education. The younger children in the groups studied seem unable to benefit materially from the form of dental health education presented in this survey and are probably unable to clean their teeth effectively in any event; the indication is that a better time for issue of dental packs would be when children leave infant schools to enter the juniors. The following summary of School Dental Services shows comparative details for 1969 in brackets0 Number of sessions Inspection 95 ( 95) Ordinary treatment 1,252 (1,220) General anaesthetic 17 (21) Health education 3 (9) Total sessions 1,367 (1,345) Inspections: Number of children given First inspection at school 6,994 (7,248) First inspection at clinic 2,187 (2,291) Proportion found to require treatment 57% (58) Reinspection at school or clinic in 1970 1,949 (1,687) Proportion found to require treatment 48% (49) Total of appointments made 12,667 (14,102) Total of attendances by appointment 9,057 (9,146) Response rate 71% ( 65) Average attendances per session 7.3 (7.6) 53 Visits for treatment: Number of first visits 2,401 (2,910) Number of subsequent visits 5,360 (5,273) Total visits 7,761 (8.183) Emergencies 128 ( 177) Additional courses commenced 499 ( 419) Treatment given: Number of fillings In permanent teeth 3,741 (3,757) In temporary teeth 3,028 (2,835) Number of extractions Of permanent teeth 195 ( 247) Of temporary teeth 799 (1,040) Number of other operations (prophylaxis, X-rays, inlays, crowns, etc.) 1,866 . (2,232) Courses of treatments completed 2,46l (2,670) Orthodontics: Number of new cases 9 ( 10) Number of removable appliances fitted 11 ( 11) Number of fixed appliances fitted Nil ( Nil ) MATERNAL AND CHILD HEALTH DENTAL SERVICES Inspections were carried out during the year at seven nursery schools and departments and three day nurseries. Fewer patients were treated than during the previous year but it is notable that the numbers of fillings for the under fives have continued the increasing trend noted in the previous year. The following summary shows comparative details for 1969 in brackets. Total number of sessions 122 (122) Expectant or nursing mothers Children under five Number of appointments 169 (195) 1,206 (1,463) Number of attendances: by appointment 125 (137) 900 (1,052) other 1 ( 4) 18 ( 11) Number of patients given first inspections during year 45 ( 34) 440 ( 472) Number of patients above found to require treatment 41 ( 32) 206 ( 250) Number of patients above offered treatment 41 ( 27) 201 ( 244) Visits for treatment: First 37 ( 41) 195 ( 232) Subsequent 67 ( 82) 391 ( 435) Number of treatments given: Fillings 100 (108) 471 ( 424) Teeth extracted 14 ( 19) 61 ( 81) Patients X-rayed 15 ( 9) 4 ( 1) Prophylaxis (patients) 19 ( 21) 21 ( 21) 54  Expectant or nursing mother Children under five Number of courses of treatment completed 25 ( 29) 42 (183) Number of patients supplied with dentures (F.U. or F.L.) first time 1 ( 4) Number of patients supplied with other dentures 1 ( 4) Number of dentures supplied 3 ( 10) Section 5 MENTAL HEALTH SERVICE 55 MENTAL HEALTH SERVICE Mr. K. Chambers Principal Mental Welfare Officer During the year under review the total number of referrals to the Mental Health Service was 1,318. This compares with 1,291 referrals for 1969. For the second year in succession the number of referrals was almost identical and this illustrates the value of the intensive casework and continued community care provided by the mental welfare officers. As stated in my last report there has been a levelling off in the referral rate and this trend continued during 1970. Staff The number of staff remained unchanged throughout 1970 and consists of Principal Mental Welfare Officer, Deputy Principal Mental Welfare Officer, 7 Senior Mental Welfare Officers, 3 Mental Welfare Officers and 2 Trainees. One of the senior officers has been seconded to the one year Younghusband Course at Enfield Technical College. As in previous years members of the staff have attended courses and seminars which have been arranged by the London Boroughs' Training Committee. A new departure has been the acceptance of students taking various social work courses at Chiswick Polytechnic for their practical social work placements. The students are supervised by senior officers of the department. Admissions to Hospital Of the persons referred during the year, 285 were admitted to psychiatric hospitals under the statutory provisions of the Mental Health Act, 1959, and a further 110 were admitted informally. These figures are similar to those recorded for 1969. Community Care Mental Welfare Officers initially visited 998 persons during the year. The number of visits made to individual patients varied according to their needs. The average case-load for officers at 31st December, 1970 was 47 and included the mentally ill and mentally handicapped. Residential Care Long term residential care was authorised for 32 persons who were mentally ill or mentally handicapped and in a further 23 cases short term care was arranged to provide relief for parents and relatives from the strain of caring for the mentally handicapped. 56 Psychiatric Day Centre In December;, the Psychiatric Day Centre previously accommodated at 92, Ladbroke Grove„ W.ll., was transferred to the new purpose-built twenty place unit at 1/9„ St,.Marks Road W..ll. Advantage has been gained by these modern and more spacious premises to provide increased facilities for the occupation and care of the patients. Because of the improved accommodation it has been possible reasonably to provide for more than this number and the persons attending have increased to an average of 27 per day. The activities of the centre are varied and consist of light industrial work, pottery. simple cooking,, dress-making and a selection of suitable handicraft activities. In order to promote and expand the activities carried out at the Centre a qualified occupational therapist and craft instructor have been appointed to the permanent staff. Social Club The Psychiatric Social Club continued to supply a need for the patients who reside in the borough. The club now meets at l/9 St. Marks Road, W.ll., and so enjoys the extra amenities provided at the new premises. This also has the added advantage of being more centrally situated than the previous venue. The patients continue to enjoy and make use of the facilities offered. Mentally Sub-normal During 1970,, 95 new cases were referred for action, e.g. community care residential care or attendance at the training centres,. The special clinic for children under 5 years of age continues and 13 possibly retarded infants were examined during the year. Training Centres The highlight of 1970 was the completion and opening of a new purpose-built combined Adult Training Centre and Psychiatric Day Centre at 1/9; St. Marks Road, W.ll., on the 23rd November, 1970. Transfer of the Adult Centre from its previous somewhat inadequate premises was eagerly looked forward to by both staff and trainees and the move was carried out smoothly and with a minimum of disruption to the normal routine of the centre The centre has the necessary facilities and equipment to ensure that an interesting and diverse programme of activities is available for the sixty trainees for when provision is made. A more comprehensive training towards socialisation has been achieved by the provision of a fully equipped kitchen,, laundry and training flatlet. An increase in the range of activities has been developed in the woodwork shop following the installation of more sophisticated machinery. Complementary to social training and handicraft activities is the continued use of formal educational methods, where appropriate, in the teaching of reading and writing. After much hard work during the period immediately prior to the opening of the centre, Mr. R.F. Potter, who had been appointed Chief Supervisor of the combined establishment suffered a severe coronary attack from which he subsequently died on the 3rd January. 1971c His untimely death was a great loss to the centre and to all who were connected with him in his work with the mentally handicapped. In May the annual holiday for the mentally handicapped who attend training centres in the Inner London Boroughs was held at Dymchurch. As in previous years, Mr. R.F. Potter of the Kensington Adult Training Centre was responsible for supervision. 57 With regard to the Junior Training Centre, formal educational methods continue to be used and at each level suitable children are being taught to read and write. Good progress is being maintained throughout the whole range of activities carried out at this centre. Adaptations to the premises were completed on the 1st December, to provide for a Special Care Unit. This Unit is designed to accommodate daily 12 severely sub-normal children with multiple handicaps who because of the nature of their disabilities require intensive care, supervision and training. The provision of an establishment of this nature within the borough meets a need which has long been recognised, Hotting Hill Neighbourhood Service The liaison with this voluntary organisation continued throughout the year under review and has been of value in the inter-change of information between the organisation and the appropriate departments of the Council. 58 MENTAL HEALTH STATISTICS 1970 Quarter Ended Total 1970 Total 1969 28.3 27.6 26.9 26.12 1. Number referred by (i) Hospital (in-patients) 100 91 50 68 309 356 (ii) Hospital (out-patients) 52 64 69 122 307 195 (iii) General practitioners 62 55 62 47 226 212 (iv) Police or Courts 2 9 3 5 19 32 (v) Other non-medical 119 125 117 96 457 496 TOTALS 335 344 301 338 1318 1291 2. Mental category of above (i) Mentally ill 306 322 268 326 1222 1194 (ii) Subnormal or severely subnormal 29 22 32 12 95 97 (iii) Psychopathic Nil Nil 1 Nil 1 Nil 3. Initially admitted to hospital (i) Informally 33 23 29 25 110 119 (ii) Compulsory Section 25 (observation) Section 26 (treatment) Section 29 (emergency) Other 41 38 51 60 190 188 1 5 5 6 17 24 24 22 16 14 76 82 Nil 1 1 Nil 2 1 TOTALS 99 89 102 105 395 414 4. Final Disposals (including patients initially admitted to hospital) (i) No further action 144 134 149 126 553 512 (ii) Hospital care 99 89 102 105 395 414 (iii) Community care 77 78- 38 100. 293 354 TOTALS 320 301 '289 331 1241 1280 Under care 3L.12.69. Referrec during 1970 Withdrawn from care 1970 Under care 31.12.70 5. Community Care 787 293 359 721 MENTAL HEALTH STATISTICS 1970 MENTALLY ILL PSYC0PATHIC SUB-NORMAL SEVERELY SUB-NORMAL TOTALS -16 16+ Elderly + 16 -16 16+ Elderly -16 16+ Elderly M F M F M F M F M F M F M F M F M F M F Individuals under L.A. care at 31.12.69 5 3 202 291 11 89 - - 34 19 32 51 - _ 8 17 15 10 - - 787 Number of referrals during 1970. 4 5 423 637 36 117 - 1 13 13 26 26 1 1 7 2 5 1 - - 1318 First Referrals Total during year 4 5 321 466 27 88 _ 1 12 12 23 23 1 1 7 2 4 1 - - 998 Total known in previous year(s) - - 82 109 5 19 - - 3 2 13 6 - - 2 9 1 - - 245 Number of individuals referred once only during year 4 5 219 295 18 59 - 1 11 11 20 20 1 1 7 2 3 1 - - 678 Subsequent referrals - during year - - 102 171 9 29 - - 1 1 3 3 - - - - 1 - - - 320 Total known during previous year(s) - - 49 94 3 14 - - - 1 2 3 - - - - 1 - - - 167 Second Referrals Total during year - - 70 110 7 2.0 - - 1 1 3 2 - - - - 1 - - - 215 Total known in previous year(s) - - 28 53 3 9 - - - 1 2 2 - - - - 1 - - - 215 Number of individuals referred twice during year - - 38 49 5 11 - - 1 1 3 1 - - - - 1 - - - 77 110 Third Referrals Total during year - - 24 37 1 6 - - - - - - - - - - - - - - 69 Total known in previous year(s) - - 16 25 - 3 - - - - - - - - - - - - - - 45 Number of individuals referred three times during year - - 16 13 - 3 - - - - - - - - - - - - - - 33 Fourth Referrals Total during year - - 6 15 1 3 - - - - - 1 - - - - - - - - 25 Total known in previous year(s) _ _ 4 10 - 2 - - - - - - - - - - - - - - 16 Number of individuals referred four times during year - - 4 6 1 3 - - - - - - - - - - - - - -- 1410 14 Referrals over four years Total during year - - 2 9 - - - - - - - - - - - - - - - - 11 Total known in previous year(s) _ _ 1 6 - - - - - - - - - - - - - - - - 7 Number of individuals referred over four times during year - - 2 9 - - - - - - - - - - - - - - - - 11 Section 6 ENVIRONMENTAL HEALTH SERVICES 61 SANITARY ADMINISTRATION OF THE BOROUGH Mr. D.C. Draper Chief Public Health Inspector The Public Health Inspectorate consists of twenty-eight public health inspectors and eleven technical assistants. For the purpose of routine inspection of premises and the investigation of complaints the Borough is divided into four areas with the overall supervision of each area the responsibility of a senior public health inspector. The four areas are sub-divided into twelve districts which are drawn on a ward basis. In addition public health inspectors are engaged in various specialised capacities, including housing, food inspection, clean air, offices and shops inspections, and improvement grants. During the year two important changes in duties took place of which details are included later in this report. Firstly the Council decided to start a programme of house to house inspections with the object of giving directions to prevent overcrowding in houses in multiple occupation. Inspections have proceeded throughout the year and a number of directions have been given. Secondly, as a result of the Housing Act, 1969 there was a considerable increase in the work connected with the giving of improvement grants. The administrative procedure for dealing with applications was streamlined so that all the duties in connection with the applications are now carried out within the department. Public control functions transferred from the Town Clerk's Department in 1968; including the licensing and supervision of employment agencies and nursing agencies, the control of some amusements with prizes and the licensing and supervision of massage establishments have continued to be undertaken. Inspections are carried out by a senior inspector and two assistants. 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. Considerable importance is attached to the training of student public health inspectors undertaken in conjunction with two technical colleges in London. The present establishment of students is seven and as they qualify they are taken on to the staff filling vacancies created by retirement and officers leaving to take up positions with other authorities. 62 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 Initial Visits Re-visits Public Health Acts 1936 and 1961 Complalnts 4,168 4,527 Infectious disease enquiries 945 Nil Drainage work inspected 7,258 2,295 Drains tested 699 Nil Clean Air Act 1956 Area survey lc 982 Nil Adaptations 592 6 Smoke emissions 92 9 Smoke observations 195 Nil Air Pollution Recording Stations 1,039 Nil New furnaces and chimney heights 89 Nil Housing Acts 1957 to 1969 Routine inspections (not included below) 984 737 Houses in multiple occupation 2,222 2,451 Overcrowding 446 447 Underground rooms 329 203 Improvement grants 1,155 1,321 General improvement areas 277 500 Factories Act 1961 Factories (mechanical) 386 3 Factories (non-mechanical) 21 Nil Outworkers 15 Nil Offices„ Shops and Railway Premises Act 1963 Offices 622 Nil Retail Shops 665 17 Wholesale shops and warehouses 22 2 Fuel Storage depots 1 Nil Catering establishments and canteens 342 65 Other visits (not general inspections) 8 ,218 29 Food and Drugs Act 1955 Butchers 48 5 Bread and cake shops 23 4 Fishmongers and friers 9 11 General provision shops 237 34 Greengrocers 44 14 Milk Vendors 34 3 Ice cream vendors 89 1 Ice cream manufacturers 4 Nil Bakehouses 5 Nil Chocolate and confectionery 24 Nil Street traders, stalls,, etc. 494 Nil Street traders' stores 1 Nil Wholesale warehouses 3 Nil Catering establishments 1,100 562 Clubs 35 1 Inspection of Food 226 Nil Sampling 534 Nil Other visits 220 7 6 3 Various Initial Visits Re-visits Noise complaints 178 145 Pet Animals Act 7 1 No—access visits 1,887 94 All other visits 6,419 210 Work Completed New items provided Drains 138 Inspection chambers 78 Intercepting chambers 15 Soil pipes 117 Waste pipes 91 Rainwater pipes 16 Water closets 493 Bidets 24 Wash-hand basins 605 Sinks 215 Baths/showers 282 Urinals 57 Hot water supplies 6 Separate cooking facilities 26 Means for space heating 2 Dustbins 12 Items cleansed or cleared Drains 31 Soil pipes 5 Waste pipes 8 Rainwater pipes 2 Cisterns 5 Noxious matter 20 Other rubbish 67 Items repaired or renewed Drains 7 Intercepting chambers 1 Soil pipes 12 Waste pipes 31 Rainwater pipes 29 Water closets 48 Wash-hand basins 8 Sinks 11 Urinals 1 Roofs 107 Gutters 6 Walls 226 Ceilings 169 Floors 80 Windows 96 Doors and frames 15 Fireplaces 4 Staircases 20 Yards and areas 3 Water waste preventers 15 Number of houses where dampness eradicated 294 Number of houses where artificial lighting to staircase provided 9 Notices Served Public Health Acts 1936 and 1961 Intimation notices 613 Statutory notices 490 Final notices 96 Housing Acts 1957 to 1964 Section 9 (repair) 4 Section 14 (deficiencies of management) 1 Section 15 (additional amenities) 3 Section 16 (means of escape from fire 3 Various Food Hygiene (General) Regulations, 1960 153 Offices, Shops & Railway Premises Act, 1963 123 Other notices 28 - 64 - MEDICINAL BATHS - PERSONAL CLEANSING STATION The following table shows the work carried out during 1970:- Description Scabies Vermin Persons Cleansings Persons Cleansings Adults Kensington & Chelsea 111 175 183 191 Other boroughs - - - - Schoolchildren Kensington & Chelsea 64 109 181 181 Other boroughs 22 46 94 94 Children under five Kensington & Chelsea 19 27 14 14 Other boroughs - - - - TOTALS 216 357 472 480 In addition to the cleansing of persons referred to above, the number of articles disinfested at the medicinal baths during the year numbered 318. DISINFECTION AND DISINFESTATION A summary of the routine work carried out in 1970 by the disinfecting staff is shown in the following table:- Houses disinfected after infectious disease 54 (134 rooms) Houses disinfested after vermin 843 (1847 rooms) Total weight of bedding, etc. dealt with 5¼ tons 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 topersons desirous of sending clothing abroad and, for this service, a standard charge is made of 50p per parcel. During the year thirty-five parcels of clothings were disinfected and the income amounted to £17.50. The following table indicates the destination of these parcels: Destination No. of parcels Argentina 5 Australia 1 East Germany 12 Romania 3 Spain 14 TOTAL 35 - 65 - 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, 1970 as follows: Treatment of premises (rats and mice) Number of properties in the borough 75,288 Total number of properties inspected following notification 2,960 Number infested by rats 29 Number infested by mice 1,863 Total number of properties inspected for rats and/or mice for reasons other than notification 5 Number infested by rats 3 Number infested by mice 5 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 2,966 Premises where rats were found 29 Premises where mice were found 1,863 Premises where other vermin were found 146 Number of visits made 20,563 Number of successful treatments 1,821 Cases in which advice only was given 242 Borough Council properties dealt with (excluding dwelling houses) 76 - 66 - 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 provides for the licensing and inspection of any establishment where the 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 on their suitability were received from the Veterinary Officer during the year. PHARMACY AND POISONS ACT 1933 At the end of the year, the number of sellers of Part II poisons (other than registered pharmacists) on the list maintained by the Council was 95. There were two 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. - 67 - 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 three samples of rag flock were taken for analysis. They were reported to be satisfactory. 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, seven 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. During the year, visists were made to all shops and stalls displaying second-hand oil heaters for sale to the public. No contraventions of the Regulations were found. In addition, investigations were made into all cases of fires involving oil heaters which were notified to the department by the fire authority. ATMOSPHERIC POLLUTION Smoke Control Areas During the year, the Council decided to make a Smoke Control Order in respect of the North and South Stanley Wards, bounded on the North by the centre of Fulham Road, on the east by the centre of Old Church Street, on the south by the high water mark of medium tides and on the west by the borough boundary. It has an area of approximately 192 acres (map reference No. C4). In making this Order, the Council exempted properties in an area bounded on the north by King's Road, on the east by Ashburnham and Cremorne Roads, on the south by Lots Road and on the west by the borough boundary. A number of these properties are to be cleared for the construction of the West Cross Route scheme and the remainder are expected to be included in projected schemes by the Greater London Council at a future date. In estimating the cost of adaptations for the whole area, no account has been taken of these latter premises. - 68 - The detailed survey showed that the total cost of adaptation will be approximately £40,850 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 £16,145. The Order was made on the 28th October, 1970, and was awaiting confirmation by the Secretary of State for the Environment at the end of the year. Smoke Control Area Map Ref. Boundaries Order operative Holland Ward (No. 1) 1 N. Holland Park Avenue 1.10.1959 E. Campden Hill Road S. Kensington High Street W. Abbotsbury Road Holland Ward (No. 3) 3 N. Notting Hill Gate 1.10.1960 E. Borough boundary S. Kensington High Street W. Campden Hill Road Church Ward C1 Church Ward boundaries 1.11.1960 Holland Ward (No. 2) 2 N. Holland Park Avenue 1.10.1961 E. Abbotsbury Road S. Kensington High Street W. Borough boundary Pembridge Ward (No. 1) 4 N. Westbourne Grove 1.10.1961 E. Borough boundary S. Notting Hill Gate W. Ladbroke Grove Pembridge Ward (No. 2) 5 N. Lancaster Road 1.10.1962 E. Borough boundary S. Westbourne Grove W. Ladbroke Grove Hans Town Ward C2 Hans Town Ward boundaries 1.11.1962 Norland Ward (No. 1) 6 N. Lancaster Road 1.10.1963 E. Ladbroke Grove S. Holland Park Avenue W. Walmer Road and Princedale Road Norland Ward (No. 2) 7 N. Lancaster Road 1.10.196^ E. Walmer Road and Princedale Road S. Holland Park Avenue W. Borough boundary Cheyne and Royal Hospital Wards C3 Cheyne Ward and Royal Hospital Ward boundaries 1. 7.1965 - 69 - Smoke Control Area Map Ref. Boundaries Order operative Earls Court and Queen's Gate Wards 8 N. Kensington High Street 1.10.1965 E. Palace Gate and Gloucester Road S. West Cromwell Road W. Borough boundary Earls Court Redcliffe and Brampton Wards 9 N. Cromwell Road and West Cromwell Road 1.10.1966 E. Queen's Gate S. Old Brompton Road W. Borough boundary Redcliffe and Brompton Wards 10 N. Old Brompton Road 1.10.1967 E. Onslow Gardens and Neville Terrace S. Fulham Road W. Borough boundary Brompton and Queen's Gate Wards 11 N. Borough boundary 1.10.1968 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 St. Charles Ward (No. 1) 12 N. Centres of North Pole Road, St. Quintin Avenue and Chesterton Road 1.10.1969 1.10.1969 E. Centre of Portobello Road S. Centre of Lancaster Road W. Borough boundary St. Charles and Golborne Wards 13 N. Borough boundary 1.10.1970 E. Borough boundary S. Centres of North Pole Road, St. Quintin Avenue, Chesterton Road, Portobello Road and Lancaster Road. W. Borough boundary - 70 - 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,, 18 notifications were received without objection to the proposals submitted. Smoke Nuisances During the year, 69 complaints of smoke nuisance were received and 195 formal smoke observations were carried out. Each case was dealt with 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:- *Sites Smoke (Microgrammes per Cubic Metre) Sulphur Dioxide (Microgrammes per Cubic Metre) Monthly Average Highest Daily Reading Monthly Average Highest Daily Reading A B C D A B C D A B A B 1969 July 33 27 63* 32 67 66 117 56 134 110 417 464 August 36 32 89* 40 69 79 213* 67 165 150 421 516 Sept. 46 38 101* 45 83 67 173* 60 180 141 427 301 Oct. 72 52 133 75 259 182 241 166 259 260 581 536 Nov. 73 64 114 70 236 174 289 150 236 225 641 429 Dec. 83 79 146 N 423 379 340 253 393 372 1230 1020 1970 Jan. 58 56 124 82 191 148 224 160 325 321 788 738 Feb. 43 37 82 48 109 87 133 79 281 249 467 538 March 42 42 N N 85 124 141 94 295 289 498 591 April 34 33 65 45 70 98 115 93 N N N N May N 37 85 45 97 81 152 73 N N N N June 33 22 84* 33 73 47 184* 67 212 186 600 452 "N" - level of readings insufficient to obtain accurate measurements: An asterisk* appearing against any average smoke concentration or highest daily figure, indicates that at least one daily figure covered by the average, or the highest daily figure itself, has been estimated from a reflectometer reading of less than 40. 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) - 71 - NOISE ABATEMENT ACT 1960 One hundred and six complaints of alleged noise nuisances were received, thirty-seven fewer than during the previous year, 66% of the complaints related to noise caused by industrial works, road works (use of pneumatic drills, compressors, etc.), building operations and miscellaneous plant and machinery in commercial premises. Noise caused by neighbouring residents in private dwellings accounted for 12% of the total complaints received and the remaining 22% 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 twenty-three 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. BYELAWS AS TO THE ARTIFICIAL LIGHTING OF COMMON STAIRCASES IN TENEMENT HOUSES AND FLATS The Council's Byelaws relating to artificial lighting of common staircases in tenement houses and flats were made on 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 1970, formal notices were served in seven instances, requiring compliance with these Byelaws, 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 Health and Social Security in Circular No. 1/71. - 72 - Part 1 of the Act 1. INSPECTIONS for the purposes of provisions as to health (including inspections made by Public Health Inspectors) Premises No. on Register Number of Inspections Written Notices Occupiers prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections 1 2, 3, 4 and 6 are to be enforced by local authorities 28 21 - - (ii) Factories not included in (l) in which Section 7 is enforced by the local authority 629 355 3 - (iii) Other premises in which Section 7 is enforced by the local authority (excluding outworkers' premises ) 33 31 1 - TOTAL 690 407 4 - 2. Cases in which DEFECTS were founds (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 Number of cases in which defects were found No of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of Cleanliness (S.l) - - - - - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) — — — — - Ineffective drainage of floors (S.6) — - — - - Sanitary conveniences (S.7) (a) Insufficient 1 — - - - (b) Unsuitable or defective 23 7 - 4 - (c) Not separate for sexes 1 - - 1 - Other offences against Act (not including offences relating to Outwork) 7 1 - - - TOTAL 32 8 - 5 - - 73 - 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 42 - - 1 - - Curtains and furniture hangings 2 - - - - - Artificial flowers 1 - - - - - Boxmaking - - - - - - Feather sorting - - - - - - Packing of glass fibre rods in - - - - - - cellophane 4 - _ — - - Lampshades 1 - — — — — TOTALS 50 - - 1 - - During the year, 15 inspections were made of outworkers' premises, and 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 - 74 - OFFICES. SHOPS MP RAILWAY PREMISES ACT 1963 The Offices, Shops and Railway Premises Act 1963. makes provision for the safety, health and welfare of persons employed in such premises. The requirements of the Act follow closely those of the Factories Act and include provisions relating to cleanliness, overcrowding, temperature, ventilation, lighting, sanitary conveniences, washing facilities, drinking water, seats, safety of machinery, first-aid and fire precautions. Enforcement of the provisions of the Act is, in most premises, the Council's responsibility, but H.M. Inspectors of Factories are responsible for the enforcement in premises which are associated with, or broadly similar in their conditions to, factories, i.e., railway premises, fuel storage depots on railway premises, and offices in factories. They are also responsible for inspecting premises owned or occupied by the Crown and those occupied by local authorities. Provisions relating to fire precautions are the responsibility of the Fire Authority. Registrations and General Inspections Class of premises Number of Premises registered during year Total number of registered premises at end of year Number of registered premises receiving general inspections during the year Offices 163 1,059 606 Retail shops 137 1,291 619 Wholesale shops, warehouses 4 49 20 Catering establishments open to the public, canteens 52 496 187 Fuel storage depots - - - TOTALS 356 2,895 1.432 Number of visits of all kinds (including general inspections) to registered premises 7,527 - 75 - Analysis by workplace of persons employed in registered premises at end of year Class of Workplace Number of persons employed Offices 16,193 Retail shops 12,404 Wholesale departments, warehouses 904 Catering establishments open to the public 5,622 Canteens 326 Fuel storage depots - TOTAL 35,449 TOTAL MALES 17,173 TOTAL FEMALES 18,276 Summary of Contraventions Section of Act Contraventions found during general inspections and routine visits made by the Public Health Inspectors Section 4 Cleanliness 51 Section 6 Temperature 217 Section 7 Ventilation 4 Section 8 Lighting 3 Section 9 Sanitary conveniences 79 Section 10 Washing facilities 52 Section 12 Accommodation for clothing 3 Section 13 Sitting facilities Section 16 Floors, passages and stairs 56 Section 24 First-aid 137 Section 49 Notification of fact persons are employed 238 Section 50 Information for employees 275 Hoists and Lifts Regulations - TOTAL 1,117 - 76 - Accidents The following tables show the total number of accidents reported during the year, and their primary causes, together with a comparison of the figures for the borough and national statistics:- Workplace Number reported Total number Investigated Action recommended Fatal Non Fatal Prosecution Formal warning Informal advice No action Offices - 24 4 - - 4 - Retail shops - 68 4 - - 4 - Wholesale shops and warehouses - 14 1 - - 1 - Catering establishments open to the public, canteens - 21 4 - - 4 - Fuel storage depots - - - - - - - TOTALS - 127 13 - - 13 - Causes of accidents Offices Retail shops Wholesale shops Warehouses Catering establishments open to the public, canteens Fuel storage depots Machinery - 5 - 3 - Transport 1 3 1 - - Falls of persons 12 17 - 8 - Stepping on or striking against object or person 5 8 - 3 — Handling goods 3 19 11 5 - Struck by falling object - 5 - - - Electrical - - - - - Use of hand tools - 7 - 2 - Not otherwise specified 3 4 2 - - - 77 - OFFICES. SHOPS AND 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 lift 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, sixty-nine such reports were received It was necessary to threaten to take legal proceedings against some occupiers after second reports had shown that lifts had not been altered or repaired to comply with the regulations. The recommendations for the fire-proofing of night-cafes have included the partition of lift shafts with material having an half-anhour fire resistance, and also the provision of doors similar to those required by the Hoists and Lifts Regulations. Lifts in registrable premises within the Borough have been listed. 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 of lifts which are absolute requirements of the principal Act, and the Regulations. LAND CHARGES The number of land charge enquiries dealt with during the year was 7,152 compared with 6,081 in 1969. These concerned outstanding statutory or informal notices, closing orders, smoke control orders. certificates of disrepair, slum clearance, etc, TOWN PLANNING APPLICATIONS During the year, 1,688 applications were referred to the Health Department for observations, compared with 1.558 in 1969. 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 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 Two hundred and thirty-seven copies of applications to the Licensing Justices (restaurant or residential 127 clubs 15 and public houses 85) 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, 23 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. - 78 - LICENCES FOR PUBLIC ENTERTAINMENT During the year, 10 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. Complaints were reported in respect of three 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 ll.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 staff canteen are excluded from this definition. Any person whose night cafe operates without being registered is liable to a fine of up to £200 or three months' imprisonment or both. 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. Thirty-three applications for registration were received, but two of these were from premises not eligible for registration. Six applications were still under consideration at the end of the year. Appeals were made to the Courts in respect of two applications refused last year. One was withdrawn and the remaining appeal was dismissed with twenty pounds costs being awarded to the Council. Kensington Police reported one unregistered restaurant being used as a night cafe after 11.00 p.m. and the Notting Hill Police reported one other. The Council prosecuted the persons concerned, one case was dismissed and the other case was proven and fines amounting to £255 were imposed. LATE NIGHT REFRESHMENT HOUSES ACT 1969 A refreshment house licence is required for any shop or other 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. Forty-two late night refreshment house licences were issued by this department during the year. - 79 - 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, 1960, and the Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966 are the principal instruments for enforcing good food hygiene practice. Premises Registered under Section 16, Food & Drugs Act 1955 For the sale, or the manufacture for the purpose of sale, of ice-cream or the storage of ice-cream intended for sale 302 For the preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale 108 The following table shows the number of inspections made of the various types of food premises in the borough during the year:- Food Premises Number of Premises Number of Inspections Bake houses 23 5 Butchers 117 53 Bread and Cake shops 156 27 Greengrocers 127 58 Confectioners 213 24 Cafes, restaurants, Public Houses, etc. 987 1662 Clubs 140 36 Fishmongers and fried fish shops 39 20 General provision shops 337 271 Street markets Stalls 103 494 Storage premises 55 1 Wholesale warehouses Other food premises 6 3 including off-licences 148 227 - 80 - 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. 1,106 informal samples were submitted for analysis, of which 89 were either adulterated or otherwise unsatisfactory. Fourteen formal samples were also submitted for analysis, of which five 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, 149 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, seven cases resulted in the Health Committee instructing that legal proceedings be instituted. The remaining one hundred and forty-two 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.) Offal 69 Meat (raw) 1,500 Cooked meat and meat products 1,759 Canned meats 252 Other canned foods 6,496 Frozen foods 23,520 Other foods 3,024 TOTAL 36,620 All food condemned as unfit for human consumption is collected by the Council, taken to the refuse destructor in Fulham, and destroyed. 81 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 tablet- Designation Licences issued in 1970 Total number in force at end of year Pasteurised milk 11 158 Sterilised milk 10 158 Ultra-heat Treated milk 2 158 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 Pasteurised *40 29 5 40 - - - - - Sterilised - — _ - - - - - - Ultra-heat Treated 8 - - - - 8 - - - P = Passed F = Failed * Of these 40 samples of pasteurised milk, 6 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 persons registered under these Regulations at the end of the year to sell milk from premises in the borough (including the sale of cream in sealed containers) was 160. 82 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 sate 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. Seven complaints were investigated during the year. One case was 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, 119 samples of milk (all grades) were submitted to the Public Analyst for examination., Five were found to be unsatisfactory. In one case, legal proceedings were instituted and the remaining four cases were dealt with informally. i 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. Fifteen genuine samples were taken during the year and the average percentages of milk fats and non-fat solids exceeded the legal minimum standards. Other Milk Average percentages of milk fat and non-fatty solids of the 103 genuine samples of milk, other than Channel Islands and South Devon milks, taken during the year exceeded the legal minimum standards. 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 stabilising agent), but permit the presence of skimmed milk solids to be declared. These Regulations also provide that it is an offence to sell under the description "ice-cream" any pre-packed ice-cream which contains fat other than milk fat, unless it bears on the wrapper or container a declaration "Contains non-milk fat" or, if appropriate, "Contains vegetable fat" in type of a prescribed minimum size. 83 The following table shows the number of samples of ice-cream taken during I969 for chemical analysis compared with those taken in the previous year 1970 1969 Number of samples 17 12 Variation of fat content per cent 3.3 to 12.6 6.0 to 11.9 Variation of non-fat content per cent 4.8 to 29.5 20.6 to 27.2 Average fat content per cent 7.61 9.24 Average non-fat content per cent 23.83 24.76 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-six samples of ice-cream were taken and submitted to the methylene blue test. The results were as follows:- Grade Number of samples 1 8 2 8 3 7 4 13 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 manufacturers1 premises and used within twentyfour hours. The Regulations prescribe the method of pasteurisation and the test to be satisfied. There are no egg pasteurisation plants in the borough and it was not found necessary during the year to take any samples of liquid egg in accordance with these Regulations. 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. 84 LICENSING AND REGISTRATIONS These functions were described in detail in my report for I969. The greater part of the work involved during the year has been in connection with licensing and inspection of employment agencies of which the number had doubled since 1st April, 1965, massage establishments. Certain provisions of the Gaming Act 1968 became operative on the 1st July, 1970 and as a result permits for amusements with prizes became the responsibility of the Licensing Justices to whom records were transferred. Two permits under the Betting, Gaming and Lotteries Act 1963 remained with this Authority, and 29 new permits were granted under the Gaming Act, 1968. This involved additional administrative duties during this current year, but the incidence of the grant and renewal of these permits should decrease in subsequent years. There was also a significant decrease in the number of shops registered during the year for the storage of fireworks. STATISTICS The following is a summary of the number of licences, permits, etc., issued during the year ended 31st December.. 1970. Licences, Permits, Etc. New Licences etc. granted during year Total in force at 31.12.70 Employment Agencies 50 180 Nurses Agencies 3 9 Massage Establishments 17 104 Theatrical Employers 5 206 Permits for the provision of amusements with prizes 31 31 Storage and sale of fireworks _ 73 Storage of celluloid and cinematograph film _ 1 85 HOUSING General Improvement Area 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 under Section 28 of the Housing Act, 1969. 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 owned by the Council containing 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 threestoried 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 have been surveyed and every endeavour is being made to persuade owners to improve their properties, where possible by converting into self-contained dwellings with the aid of the increased grants now available. Progress has not been as rapid as had been hoped originally, but in the past twelve months there has been a slow but steady movement in the general improvement of the whole area. Work on the conversion of one block of nine substantial properties has progressed during the year and a number of other conversions are in progress as anticipated. It is probable that where no action is taken by owners to bring their properties up to a satisfactory standard, the Council will have to rely upon their statutory powers under the Housing Acts to secure repairs and improvements. Qualification Certificates The following shows the number of applications for qualification certificates dealt with during the year - Applications under section 44(1) - to provide amenities Applications received 485 Qualification Certificates issued 155 Qualification Certificates refused 97 Applications under section 44(2) - amenities provided Applications received 32 Provisional Certificates issued 23 Provisional Certificates refused Nil Qualification Certificates issued 1 There were 233 applications under section 44(1) still outstanding at the end of the year. The majority of these related to one large block of flats where the applications were submitted in November. Items of disrepair were found in most of the flats when they were inspected and the owners were therefore given an opportunity of remedying these defects so that the Council could issue qualification certificates in due course. 86 GRANTS FOR THE IMPROVEMENT OR CONVERSION OF PRIVATE DWELLINGS Standard Grants Twenty-two applications for standard grants were approved by the Council during 1970, compared with four applications for the previous year. Improvement (Discretionary) Grants There was a considerable, but expected, increase in applications for discretionary grants received during the year, and the actual amount of grant approved by the Council was greater than the combined total for the previous eighteen years. The following is a summary of the number of discretionary grants dealt with during 1970, together with a graph showing comparative figures since the present borough was formed in 1965 - Applications granted 704 Applications refused Nil Total amount of grants approved £649,006 87 HOUSES IN MULTIPLE OCCUPATION Directions to prevent or reduce Overcrowding Early in 1970, the Council decided to augment their overcrowding policy by issuing Directions under section 19 of the Housing Act, 1961, as amended by the Housing Act, 1969. This procedure enables the Council to set a maximum limit on the number of households or individuals, or both, who may occupy a house in multiple occupation, having regard to the amenities and facilities provided. The purpose of fixing such a limit is to prevent the occurrence of, or to remedy, overcrowding. Where a Direction is given by the Council, it is an offence for any fixture letting to exceed the numbers stipulated by the Direction. Staff were duly appointed and work was commenced in June 1970. The area initially chosen covered those parts of the Golborne and Pembridge Wards not likely to be affected by redevelopment schemes. By the end of the year, 382 houses had been inspected, Notices of Intention to give Directions had been served in respect of 229 houses, and 151 Directions had been given. Certificates of Disrepair in relation to Dwelling Houses The Council's duty to issue certificates of disrepair in respect of "rent controlled" dwelling houses, not reasonably suitable for occupation is governed by the Rent Acts. It was not found necessary to take any action regarding certificates of disrepair during 1970. 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 Committee during 1970 was 81 (26 penal and 55 non-penal), giving an equivalent number of persons of 317½ The total number of recorded cases where overcrowding was abated during the year was 210, comprising a total of 8l6½ units. Since October, 1945, 2,889 cases have been reported, and the number of cases remaining on the register at the end of this year was 81 (10 penal and 71 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 347 Houses repaired after service of formal notices under the Public Health Acts 354 Houses made fit after service of formal notices under Section 9 of the Housing Act 1957 (a) by owners 12 (b) by local authority in default 3 88 Individual Unfit House and Parts of Houses (Cont'd) 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 15 (27 rooms) (b) closing ordeis determined 8 (16 rooms) (c) closing orders cancelled (premises demolished) Nil (d) consent given to use of closed rooms for non-sleeping purposes 7 (12 rooms) (e) undertakings accepted from owners to render part of building fit for habitation 1(2 rooms) (f) part of building rendered fit and undertaking cancelled Nil Assessment of Housing Priorities on Medical Grounds During the year, 238 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 informations and that supplied by the Chief Housing Officer an assessment of points to be awarded on medical grounds was made in 205 cases. LEGAL PROCEEDINGS Public Health Acts, 1936/1961 - Nuisances During the year, fifty summonses were issued for various nuisances under the Public Health Act, 1936/l961. In nineteen cases. Abatement Orders were secured, fines totalling £179.00 and costs amounting to £102.25 were obtained. In twenty three cases, the summonses were withdrawn and in two cases the summonses were dismissed; the nuisances having been abated prior to the.Court hearings. In three cases the summonses were adjourned sine die, as the necessary works were being carried out by the defendants; In the remaining three cases, one was adjourned, one was dismissed and in the final case the Court made an order for the nuisance to be remedied in four months. 89 Housing Act. 1957 Overcrowding Two summonses were issued for permitting dwelling houses to be overcrowded. At the Court Hearing one case was adjourned sine die and in the other case the offender was granted an absolute discharge and the Council were awarded £5.00 costs. Illegal Occupation of Closed, Unfit Rooms Ten summonses were issued in respect of the illegal occupation of closed basement rooms. In three cases the summonses were withdrawn and re-served on the new owner who was granted an absolute discharge and the Council were awarded £5.00 costs. In six cases the owner was granted an absolute discharge and in the final case the owner was fined £2.00 and the Council were awarded £4.00 costs. Food and Drugs Act, 1955 The Preservatives in Food Regulations, 1962 Two summonses were issued in respect of the sale of Anchovy Fillets and Chili Sauce which contained added preservative (Benzoic Acid) not permitted by the Regulations. One case was withdrawn by the Borough Solicitor and in the other case a conviction was obtained and a fine of £30.00 was imposed, the Council being awarded £10.50 costs. The Food Hygiene (General) Regulations. I960 Four summonses were issued in respect of 70 contraventions of these Regulations, as follows:- Case No.l (15 contraventions) A conviction was obtained in each instance. Fines amounting to £170 were imposed in respect of eleven of the contraventions and the owner was given an absolute discharge in respect of the other four. Costs amounting to £20 were awarded to the Council. Case No.2 (8 contraventions) An absolute discharge was given in respect of each of the contraventions. Case No.3 (26 contraventions) A conviction was obtained in each instance. Fines amounting to £210 were imposed in respect of 17 of the contraventions and the owner was given a conditional discharge for two years in respect of the other nine. Costs amounting to £20 were awarded to the Council. Case No.4 (21 contraventions) There were two defendants in this case. A conviction was obtained in each instance. Fines amounting to £148 were imposed on each defendant in respect of ten of the contraventions. One defendant was given a conditional discharge in respect of 10 of the contraventions and an absolute discharge in respect of one. The other defendant was given a conditional discharge in respect of one contravention and an absolute discharge in respect of ten. Costs amounting to £20 were awarded to the Council. 90 Section 2 - Offences Eleven summonses were issued in respect of the sale of food not of the nature, substance or quality demanded. In eight cases convictions were obtained and fines totalling £235.00 were imposed, and the Council were awarded £70.00 costs. Two cases were withdrawn and the remaining case was dismissed as the defendant pleaded warranty. Greater London Council (General Powers) Act. 1968 Eleven summonses were issued for using premises as night cafes when not registered with the Council, after 2nd June, 1968. In nine cases convictions were obtained, fines totalling £255.00 were imposed and the Council were awarded £90.00 costs, one case was dropped and the other case was dismissed with costs of £10.00 awarded against the Council. Two appeals were heard against the Council's refusal to register premises as night cafes. One appeal was withdrawn and the other one was dismissed, costs being awarded to the Council amounting to £20.00. Section 7 WELFARE SERVICES 91 WELFARE SERVICES Mr. S.A. Biddlecombe Chief Welfare Officer The duties and powers of the local welfare authority are contained in the National Assistance Act, 1948, as amended; the main provisions of which are as follows (a) Residential accommodation for persons in need of care and attention. (b) Temporary accommodation for the homeless. (c) Comprehensive services for the blind, partially sighted, deaf and other handicapped persons including special residential accommodation, workshops, occupational and rehabilitation centres, holidays and other amenities , and a full range of domiciliary services, including a casework service. (d) Domiciliary services for the aged, provided either directly or in co-operation with voluntary organisations. (e) Contributions to organisations engaged in promoting the welfare of handicapped and elderly persons. (f) Registration and inspection of homes for the disabled and elderly. (g) Removal to suitable premises of persons in need of care and attention. (h) Temporary protection of property of persons admitted to hospital, etc. (i) Burial or cremation of persons found dead when no suitable arrangements have been, or can be, made. 92 FORWARD PLANNING Residential Home for the Elderly - King's Mead Reference was made in last year's report to the running down programme of King's Mead, which accommodated 317 men and women. During 1970 it was possible to close 92 beds when the purpose-built home at Northolt, Dovehouse Court was fully operational. During the year the building works on the second replacement home for 6l residents has continued, and although there have been some delays it is hoped that the builder will hand this home over to the Council in August, 1971. The plans for the final replacement home were approved during the year and building works will start early in 1971 on a site adjoining the existing King's Mead. Temporary Accommodation The Greater London Council have confirmed that the premises 144/148, Earls Court Road at present used by the Social Services Committee to provide 16 units of temporary accommodation will be required for the widening and redeveloping of the West Cromwell Road by 1st September, 1971. The new building of eight units in course of erection on the Trenmar Lodge site is due to be completed on 1st September, 1971, and negotiations are in hand to acquire a building for conversion to a further 8 units. These two units will replace the 16 units at 144/148, Earls Court Road. RESIDENTIAL ACCOMMODATION The number of persons in residential accommodation at 31st December, 1970 was as follows Council accommodation 469 Other local authority homes Voluntary homes 10 216 Total 695 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 90 " " " Ellesmere 116 " " " King's Mead 191 " " " 59 Holland Park 29 women Total 481 93 There were 221 new admissions and 140 discharges from the Council's homes during 1970. In the same period, 96 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 74 and discharges to hospital amounted to 154. Age Analysis at 31st December 1970. (Where figures are shown in brackets they relate to the previous year and are included for comparison.) Home Total Dovehouse Court King's Mead Ellesmere Dale Mead No. 5. Holland Park Under 30 years Male - - - - - - Female - - - - - - 30 - 49 years Male - 1 - - - 1 Female 1 1 - - - 2 50 - 64 years Male 2 4 3 - - 9 Female 3 3 - - 3 9 65 - 74 years Male 10 15 6 4 - 35 Female 12 25 12 7 5 61 75-84 years Male 16 21 14 6 - 57 Female 23 61 44 17 14 159 85 years and over Male 3 10 6 2 - 21 Female 18 50 25 13 6 112 TOTALS: Male 31 51 29 12 - 123 Female 57 140 81 37 28 343 Average Age 76.5 78.5 77 79.6 77 80.8 (Average Age 31.12.69) 67.9 78.6 79.2 81.5 79.6 77.3 94 Admissions and Discharges The following statistics show the admission and discharges at each residential home for the period, 1st January to 31st December 1970. HOME TOTAL Dale Mead Dovehouse Court Ellesmere No. 5 Holland Park King's Mead Resident on 1.1.70 Men 13 12 31 - 71 127 Women 40 22 80 30 198 370 Total 53 34 111 30 269 497 (487) Admission Men 7 32 20 - 66 125 Women 16 62 59 16 131 284 Total 23 94 79 16 197 409 (323) Discharges (perm) Men 4 7 22 - 77 110 Women 10 25 53 18 131 237 Total 14 32 75 18 208 347 (187) Died Men 4 4 - - 11 19 Women 4 4 5 - 58 71 Total 8 8 5 - 69 90 (119) Remaining on 31.12.70 Men 12 33 29 _ 49 123 Women 42 55 81 28 140 346 Total 54 88 110 28 189 469 (496) Normal accommodation 55 90 116 29 191 481 (519) (Figures for previous year shown in parentheses) 95 Other Local Authority Homes Section 21(1)(4) NationalAssistarfce 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 secur residential care for the applicant. The number of persons assisted in this way during the year is shown in the followin table:- Name of Home Owning Borough Resident on 1.1.70 Admitted Discharged i Died Remaining on 31.12.70 Men Women Total Men Women Total Men Women Total Men Women Total Men Women Total Ashmead Wandsworth 1 — 1 — — — — — — 1 — 1 — — — Bedford Lodge Croydon — — — — 1 1 — — — — — — — 1 1 Brockle Bank Wandsworth 1 — 1 — — — — — — — — — 1 — 1 Fitzjohn's Avenue Camden — 1 1 — — — — — — — — — — 1 1 The Gables Hampshire — 1 1 — — — — — — — — — — 1 1 Hillside Islington — 1 1 — — — — — — — — — — 1 1 Kenwolde Westminster — 1 1 — — — — — — — — — — 1 1 The Leys Barnet — 1 1 — — — — — — — 1 1 — — — Moorcroft Hillingdon — 1 1 — — — — — — — 1 1 — — — Shirley Old Peoples Home Croydon — 1 1 — — — — 1 1 — — — — — — Somerville Camden — 1 1 — — — — 1 1 — — — — — — Sto Vincent's Lodge Portsmouth — — — 1 — 1 — — — — — — 1 — 1 Thomas Taylor Homes Northumberland — 1 1 — — — — — — — — — — 1 1 White Chester Hammersmith — 1 1 — — — — — — — — — — 1 1 Whitby Dene Hillingdon — 1 1 — — — — — — — — — — 1 1 TOTAL 2 11 13 1 1 2 — 2 2 1 2 3 2 8 10 96 Accommodation provided by Voluntary Organisations On 31st December, 1970,, there were 196 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 1 16 Deaf 2 1 Epileptic 3 - Physically handicapped 18 21 Others 7 147 Total 31 (31) 185 (176) By age and sex Male Female Under 30 years 1 2 30 — 49 years 3 4 50 — 64 years 7 13 65 — 74 years 10 28 75 — 84 years 18 77 85 years and over 5 48 Total 44 (42) 172 (165) Seventy-six homes were used for this purpose. Waiting List for Admission to Homes for Aged Persons There were 103 persons on the waiting list for admission to residential accommodation at 31st December. 1970, viz:- Urgent Applications for Admission Normal Applications for Admission Total Men 16 9 25 Women 34 44 78 TOTAL 50 53 103 (53) (37) (90) Names were added to the waiting list at the rate of 23 persons per month. In cases of genuine emergency 45 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. - 97 - TEMPORARY ACCOMMODATION Homeless Families The Council has a responsibility under Section 21(1)(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 or flood whilst they are temporarily homeless. The premises in use for homeless families are as follows:- 144/148, Earls Court Road, S.W.5. 68, Holland Road, W.l4. 16/18, Wrights Lane, W.8. 68, Oxford Gardens, W.10. 228, Lancaster Road, W.11. 84/90, Princedale Road, W.11. 32, Dawson Place, W.2. 201, Ladbroke Grove, W.11. 210, Ladbroke Grove, W.11. Trenmar Lodge, Trenmar Gardens, N.W.10. 16 family units available for use up to 7 family units 16 family units 3 family units 5 family units 11 family units 7 family units 5 family units 5 family units 9 family units Families admitted received social work support and intensive case work guidance where necessary* This approach has proved to be helpful in rehabilitating and preparing families for eventual rehousing and helps to keep to a minimum the number of otherwise long stay cases which could create a heavy demand for additional units of accommodation. Details follow of families received into and discharged from temporary accommodation during the year:- Number of families in temporary accommodation as at 31.l2.69 70 Number of families admitted (comprising 44 men, 81 women and 200 children) 80 Number of families discharged 96 Number of families remaining as at 31.12.70 54 The reasons for homelessness were as follows:- Unauthorised occupants 29 Rent arrears 9 Overcrowding 7 From hotel accommodation 7 New to London 5 Sale of property 5 Disputes with landlord 4 Family disputes 3 Conversion of property 3 Service contract ended 2 Landlord wanted accommodation 2 Other reasons (including fire victims, condemned property, objection to children and expiry of lease) 22 - 98 - Of the 96 discharges. 22 were rehoused by the Council, 27 by the Greater London Council and Housing Associations, 38 were assisted to find accommodation and 9 found their own accommodation. The casework approach of the family caseworkers is based principally on three main conditions:- (a) Acceptance by the families of their financial responsibility, regular payment of charges,, proper budgeting and the payment of any outstanding debts including rent arrears. (b) Advising the parents how to obtain good standards of child care, i.e., correct feeding, clothing and reasonable discipline; appreciation of the value of good school attendance and a constant care of the health and well-being of the family. (c) Acceptance by the husband of the necessity of retaining full employment. Encouragement and assistance is given when necessary The response shown by families was encouraging and resulted in rehousing within a period of twelve months in most cases. 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. Admission to one of the homes run by voluntary societies is arranged for a suitable period before and after confinement. The Council pay an agreed weekly charge. By arrangement with the London Boroughs of Lewis ham and Lambeth mothers requiring emergency admission, physically handicapped or in need of greater support, were sent to "Ballantyne" and "Carisbrooke" Mother and Baby Homes respectively, where there are special facilities. Both homes have now closed and arrangements have been made with the London Borough of Ealing for mothers who are not acceptable to the voluntary organisations to be admitted to that Council's Mother and Baby unit, "Amherst Lodge", 47, Amherst Road, W.13. The following tables show the numbers accommodated during the year:- (a) Voluntary Homes Mothers Children Total Number in residence at 31.12.69 13 6 19 ( 19) Admitted 67 67 134 (108) Discharged 63 63 126 (108) Number remaining at 31.12.70 17 10 27 ( 19) Country of Origin of Mothers Admitted United Kingdom 31 Spain 1 Sire 19 New Zealand 1 Australia 4 Italy 1 Portugal 3 Czechozlovakia 1 Canada 2 Uganda 1 West Indies 1 Greece 1 Egypt 1 Total 67 (54) - 99 - (b) Other Homes "Ballantyne", Lewis ham Mothers Children Total Number in residence at 31.12.69 2 2 4 Admitted 1 1 2 Discharged 3 3 6 Number in residence at 31.12.70 - - - Country of Origin of Mothers Admitted Eire 1 Total 1 (14) "Carisbrooke", Lambeth Mothers Children Total Number in residence at 31.12.69 - - - Admitted 1 1 2 Discharged 1 1 2 Number in residence at 31°12o70 - - - Country of Origin of Mothers Admitted Eire 1 Total 1 (Nil) 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 for promoting the welfare of persons who are substantially and permanently handicapped. 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. A register is also kept of 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, 1970:- Blind 401 ( 405) Partially sighted 139 ( 124) Physically Handicapped 1,619 (1,514) Deaf/hard of hearing 69 ( 69) Elderly persons 4,476 (4,592) Total of all Registers 6,704 (6,704) 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. A wide variety of services is. made available, which includes the teaching of Braille and Moon type to blind people, homecraft instruction, the provision of aids and appliances and adaptations in the. home, holidays, home chiropody treatment, meals on wheels, mobile library services and a laundry service in certain cases of chronic illness. - 100 - During the year 10,981 (12,300) 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, 1,598 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 300. 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 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.) 100. 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. 6945. 0. 0. Kensington and Chelsea Old People's Welfare Committee 4100. 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 People's Welfare Committee made the following grants from its funds St. Thomas' Church Old Peoples Club 10. 0. 0. Salvation Army Notting Hill Over 60's 10. 0. 0. Chelsea Com. Centre Luncheon Club 10. 0. 0. Catholic Womens' League - Outing 10, 0. 0. St. Mary Abbots Club 50. 0. 0. Chelsea Housing Impr. Society 15. 0. 0. Rugby Club - O.A.P. Outing 15. 0. 0. St. Pauls' Church Hall Luncheon Club equipment 54. 0. 0. Alexander & Sevenick Teachers Club 45. 0. 0. Salvation Army, Notting Hill Corps Luncheon Club equipment 50. 0. 0. Notting Hill Adventure Playground O.A.P. Club Outing. 25. 0. 0. Greater London Conf. on Old Peoples Welfare 5. 5. 0. West London Angling Committee 5. 0. 0. - 101 - WELFARE OF THE BLIND The statutory definition for the purpose of registration as a blind person under the National Assistance Act, 1948, is that the person is "so blind as to be unable to perform any work for which eyesight is essential". The number of persons newly registered as blind during 1969 was 62, 15 men and 47 women„ Table I shows the distribution in age groups of the 401 registered blind persons ordinarily resident in the Borough. The majority of new registrations are in the age groups of sixty-five and over, which is consistent with figures produced for national statistics. The analysis of causes of blindness in newly registered persons is shown in Table II. An analysis of the register showing the education, training and employment position is given in Tables III and IV. It will be seen that a total of 281 persons are over sixty-five years of age, leaving a total of 117 adults, of whom 67 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 20 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 1,047. A brief summary of the special facilities available to registered blind persons is given belows:- 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. - 102 - Table I - Blind Persons (Registered) for the Year Ended 31st December, 1970, showing the distribution by age groups of the blind population New cases in 1970 All cases (old and new) Male Female Total Male Female Total Under 1 year - - - - - - 1 year - - - - - - 2 years - - - - - - 3 years - - - - - - 4 years - - - - 1 1 5-10 years 1 - 1 2 - 2 11 - 15 years - - - - - - 16 - 20 years 1 - 1 3 5 8 21-29 years - 1 1 11 6 17 30 - 39 years 1 1 2 10 6 16 40 - 49 years 1 1 2 9 9 18 50 - 59 years 1 1 2 19 14 33 60-64 years 1 1 2 10 14 24 65 - 69 years - 3 3 6 17 23 70 - 79 years 3 12 15 25 66 91 8-84 years 4 12 16 9 52 61 85-89 years 2 9 11 11 52 63 90 years & over - 6 6 8 36 44 Unknown - - - - - - 15 47 62 123 278 401 (418) Table II - Analysis of Cause of Blindness of Persons Newly Registered During 1970 Cause Male Female Total Choroidal Sclerosis - 1 1 Detached Retina - 3 3 Cataract 2 11 13 Senile Macular Degeneration 4 16 20 Retinopathy 1 - 1 Myopia - 2 2 Glaucoma 3 8 11 Optic Atrophy 3 3 6 Others 2 3 5 15 47 62 - 103 - Table III - Summary of Occupations of Blind Persons at 31st December, 1970. Male Female Total Children Aged 2-4 years - 1 1 Aged 5-15 years (educable) - - - attending special schools - - - attending other schools (ineducable) 1 - 1 Mentally Sub-normal 1 - 1 Adults aged 16 years and upwards At schools - - - Employed in sheltered workshops 2 1 3 Employed in open employment 29 18 47 Trainee for open employment 2 1 3 Unemployed but capable and available for work; already trained 1 2 3 Subject to training for open employment 1 1 2 Subject to training for sheltered employment 7 - 7 Without training in open employment 2 - 2 Not available for work, aged 16 - 64 17 22 39 Not capable of work, aged 16 - 64 2 9 11 Not employed, aged over 65 58 223 281 TOTAL 123 278 401 Table IV - Analysis of the Occupation of Employed Blind Persons shown in Table III Sheltered Workshops Home Workers Schemes Ordinary Conditions Total Machine Operators - - 3 3 Masseurs and Physiotherapists - - 1 1 Lecturers, Teachers - - 2 2 Barristers, Solicitors - - 2 2 Managers, Executives - - 5 5 Typists, Secretaries - - 18 18 Braille Copyists - - 3 3 Clerical Workers - - 1 1 Telephone Operators - - 7 7 Filler and packer - - 1 1 Machine Knitter 1 - - 1 Basket Makers 2 - - 2 Piano Tuners - - 2 2 Domestic Worker - - 1 1 Placement Officer - - 1 1 TOTAL 3 - 47 50 - 104 - PARTIALLY SIGHTED PERSONS There is no statutory definition in the National Assistance Act, 1948, of partial sight, but the Department of Health and Social Security has advised that a person who although not blind within the meaning of the Act of 1948, is, nevertheless, substantially and permanently handicapped by congenitally defective vision or in whose case illness or injury has caused defective vision of a substantial and permanently handicapping character is within the scope of the Welfare Services which the local authority are empowered to provide for blind persons. This does not apply to other benefits specially enjoyed by the registered blind. The register of partially sighted persons (Table I) shows a total of 139 (124), of whom 52 (31) were newly registered during the year (Table II). Training and Employment Severely handicapped There are fifty-three persons near and prospectively blind who require the full range of Welfare Services. Their circumstances are as follows:- Male Female Total Employed 3 6 9 Undergoing training 1 - 1 Not available for employment or not capable of work 4 39 43 8 45 53 (53) Requiring observation only - 15 15 (12) Industrially handicapped The remaining persons registered are classified thus;- Employed 7 2 9 Undergoing training - 1 1 Available for and capable of training for work 1 - 1 Not available for work 7 53 60 15 56 71 (63) Table I - Partially Sighted Persons (Registered) for the Year Ended 31st December, 1970, Showing the Distribution by Age Groups of the Partially Sighted Population 0-1 2-4 5-15 16-20 21-49 50-64 65 and over Total Males - - 1 - 11 2 10 24 Females - - - 1 6 9 99 115 TOTAL - - 1 1 17 11 109 139 (124) - 105 - 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 - 5 6 Females - - - - 2 1 43 46 TOTAL - - - - 3 1 48 52 (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 - - - - 1 - - 1 Females - - - - 1 - 10 11 - - - - 2 - 10 12 (14) . (ii) One female (Group 65+) was decertified due to improved visual acuity. Table IV - Analysis of Causes of Partial Sight of Persons Newly Registered During 1970 Cause Male Female Total Macular Degeneration - 10 10 Cataract 5 18 23 Aphakia - 2 2 Glaucoma - 6 6 Arteriosclerosis - 1 1 Choroidal Sclerosis - 1 1 Myopia - 1 1 Others 1 7 8 TOTAL 6 46 52 (31) WELFARE OF THE BLIND AND PARTIALLY SIGHTED Although there has been an increase in the number of applicants for registration as blind or partially sighted under the provisions of the National Assistance Act. 1948, the number of registrations as blind resulting from examinations has decreased but the proportion of such registrations remains about the same. The Council continued to employ two consultant ophthalmologists for medical examination and assessment,. - 106 - Details of examinations and findings are as follows 1970 Number of examinations by Council's ophthalmologist 130 (124) Number of hospital certificates accepted 34 ( 42) Number of new cases registered-blind 45 ( 55) Number of new cases registeredpartially sighted 41 ( 32) Re-examinations:- Number previously registered as blind and now found to be partially sighted 2 ( 1) Number previously registered as partially sighted and now found to be blind 12 ( 13) Number examined and found not to be registerable as blind or partially sighted 2 ( 5) Number previously registered as blind or partially sighted and now found to be not registerable 2 ( 1) Number previously not registerable and found to be partially sighted 3 ( 2) Number examined and no change found in category 57 ( 57) 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 statutory or voluntary which appear 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. - 107 - (h) To take such steps as are practicable in consultation with the Department of Employment and Productivity to assist handicapped persons to secure any work for which they appear to be fitted and wish to obtain,, (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, 1970, showed a total of 1,619. During the year, 373 names 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 (overleaf). An analysis of the disabilities of the newly registered cases is shown in Table II (page 109). 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 4,440 home visits. Arising from these visits, many needs have been brought to notice and as a result 348 items of equipment have been supplied at a cost of £940.13s.8d. In addition, articles of medical loan equipment were issued where necessary. - 108 - 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 - 3 3 15 21 42 F Arthritis or Rheumatism - - 7 71 434 512 G Congenital malformations or deformities 3 1 1 6 14 25 H/L Diseases of the digestive and genito-urinary, heart, circulatory and respiratory systems - 2 12 49 288 351 Q/T Injuries of head, face, neck, thorax, abdomen, pelvis, trunk, limbs and spine 1 4 17 33 160 215 V Organic nervous diseases, epilepsy poliomyelitis, multiple sclerosis etc. 2 18 49 110 156 335 U/W Neuroses, psychoses other than in 'V' above - - 1 2 23 26 X&Y Tuberculosis, respiratory and non-respiratory - - 2 6 3 11 Z Diseases and injuries not specified - - 6 11 84 101 TOTAL 6 (9) 28 (30) 98 (106) 303 (313) 1183 (1056) 1618 (1514) - 109 - Table II - New Registrations During 1970 - Analysis of Disabilities Disability No. of Persons Disability No. of Persons Acromegaly 1 Hemiplegia 25 Amputation 5 Hernia 4 Anaemia 3 Hypertension 8 Angina 1 Multiple sclerosis 3 Arthritis 106 Neuritis 3 Asthma 6 Paraplegia 1 Bronchitis 26 Parkinsons disease 6 Cancer 13 Phlebitis 1 Cardiac condition 51 Poliomyelitis 8 Colostomy 3 Rheumatism 5 Deformed knee 1 Senility 6 Diabetes 20 Spinal deformity 1 Disseminated sclerosis 1 Spinal injury 11 Diverticulitis 1 Spasticity 1 Epilepsy 4 Stroke 11 Fractured femur 16 Thrombosis 3 Gangrene 1 Tuberculosis 1 Gigantism 1 Ulcers - leg 9 Gout 1 Ulcers - stomach 3 Varicose veins 2 TOTAL 373 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 homes 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 service on over 520 occasions. The toal mileage travelled in covering all these commitments amounted to 57,000 (53,000) miles. - 110 - WELFARE OF THE ELDERLY At 1st January, 1970, the number of elderly persons shown on the register was 4,592. 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 675 new registrations were made and 767 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, 1970 totalled 4,476. 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 1,260 meals a week are prepared, including those supplied to luncheon clubs. The preparation of meals for delivery in Chelsea is undertaken from the kitchen in King's Mead old people's home where an average of 370 meals a week are prepared. Deliveries in both areas have been effected by volunteer drivers and attendants of the Women's Royal Voluntary Service, The meals are delivered in a fleet of eight vans, seven of which are fitted with equipment for keeping the food hot. The charge to the recipient was l/2d per meal. The total number of meals supplied was as follows:- January 8,485 February 6,951 March 7,095 April 7,684 May 6,245 June 7,957 July 6,487 August 6,612 September 7,956 October 6,705 November 6,701 December 6,500 85,378 (84,501) Of these 55,667 (55,941) 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 334 and on 31st December, 1970, there were 352 persons in receipt of meals. - 111 - 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 health. Fouled bed linen in cases of incontinence may be cleansed 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 76 (80) cases. The bedding was marked, collected and laundered at the Council's disinfecting station at Silchester Road Baths and returned to the persons' homes, This service meets a real need. During the year 2,500 (2,820) separate collections of laundry were made and the number of articles cleansed totalled 31,497 (34,654). Holidays A booking for 200 active elderly people was arranged at various hotels at Cliftonville, 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 Camps, 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 a number of volunteers. Due to the temporary closure of Crabhill House, the more severely handicapped spent a very enjoyable holiday at Mary's Mead, near Sevenoaks, a holiday home run by the Multiple Sclerosis Society, The total number of people for whom two weeks holiday was arranged was 400 (370) of whom the majority were elderly but some were blind and physically handicapped. The gross cost to the Council for all holidays was £7,770 (£7,045). SOCIAL AND REHABILITATION CENTRE The Centre which is in its fifth full year of operation provides a daily service to its members who are blind, physically handicapped or elderly. Membership on 31st December, 1970, was 139 (122). The staff consists of the Supervisor, Deputy Supervisor, Attendant, kitchen staff and a part-time handyman/porter. Since November cleaning has been carried out under contract the cost of which is offset by not retaining the services of the cleaning staff. The main activity of the members is handicraft work under the instruction of tutors engaged through the Inner London Education Authority. Instruction continues in carpentry,, 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 midday lunch together with morning and afternoon tea is provided. On their - 112 - annual Summer Outing the members were taken to Southend, The outing, which included a meal, was greatly enjoyed by all. In October the Annual Open Day and 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. The sum raised from the sale of articles was £129. 5s. 9d, The Christmas party which was held at the Centre was very well attended and was most successful, Task Force Emphasis is now being placed upon the continuity of the volunteers with their respective clients thus building lasting friendships based on mutual trust and confidence. Of the 440 elderly persons visited during the year, 300 were visited regularly each week, Approximately 93 decorating jobs and 1,059 other jobs such as window cleaning, gardening, shopping etc,, W6re done during the year. The number of volunteers involved included:- 410 individual volunteers (not attached to any organisation or group), 130 volunteers from 6 school groups. 80 volunteers from Youth Clubs. In many cases the service of Task Force is of dual benefit - it gives to the volunteer a chance of satisfying his or her desire to serve the community and attain a responsible social conscience, They also become aware of the services available through statutory and voluntary organisations and perhaps more important, how they can be obtained while at the same time providing elderly persons with the very essential feeling of being needed and part of the community. Much of the work performed by Task Force is done during the weekends, when the recognised statutory and voluntary services are not available. Co-ordination of services with other voluntary organisations 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 3,364 visits to 657 individual persons. Administrative assistance for this service was provided by the British Red Cross Society, Library Facilities The Libraries Committee authorised the provision of suitable books including large print (Ulverscroft Print) for old people 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 191 (177). Number of books issued was 14,588. Advice Leaflets The publication and distribution of pamphlets giving information on the services available to old people was continued by the Old People's Welfare Committee, Approximately 2,000 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, - 113 - Social Activities There are 24 Social Clubs for the elderly in the Royal Borough, 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. In addition four Health Centres organise clubs for the over 50's with emphasis on health, diets and home safety. A small subscription which generally provides for a cup of tea and biscuits is collected weekly and any balance is directed towards the cost of outings and a Christmas Party, Clubs hold a weekly raffle and other games for which a small charge is made; any profits help to offset club expenses. Old Time Dancing and Arts and Crafts classes continue to be held at the Chelsea and North Kensington Community Centres, The Christmas parcel which has for so long been a feature of the elderly persons Christmas was this year substituted, as an experiment, by a gift voucher. United Dairies Ltd., Express Dairies Ltd,, and the London Co-operative Society agreed to accept these vouchers in exchange for goods or milk to the value of 10/-, A total of 2,100 vouchers each with a Christmas card were delivered by hand by volunteers. Some 396 parcels and gifts were delivered to selected needy persons by various voluntary organisations and individuals. 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 approximately 300 people with 50 volunteers (escorts, chair pushers and car drivers) from this and adjoining boroughs took advantage of the opportunity to shop in comfort. This facility was greatly appreciated, Christmas dinners were arranged for the elderly lonely by a local publican, a school and the North Kensington Community Centre, Several organisations and individuals also invited 153 people to dinner on Christmas Day, Instead of the usual concerts for the elderly at Kensington and Chelsea Town Halls, a block booking for 1,000 elderly persons has been made for the Ice Show "Jack and the Beanstalk" at Wembley on the 13th January, 1971. Although the cost will exceed the amount expended on the concerts, it is felt that the extra will be well spent if it attracts and satisfies the increased number of persons catered for. Coaches have been booked and will leave from six assembly points. A party of 300 elderly people were taken on a day's outing to Bognor; 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 225 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. - 114 - 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 twentyseven 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. No special appeal was promoted during the year, but from several small functions, such as coffee mornings, raffles and a Christmas draw an amount of £303. 10s. 10d., was collected. 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 the Christmas activities for 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 £196. Kensington Day Centre Limited Close liaison was maintained with the Centre which has a membership of 300 elderly and handicapped persons. The Centre is open each weekday and provision is made for recreation and occupational therapy, a chiropody service, hairdressing and bathing facilities, library services and mid-day meals. The Council provides two hydraulic tail-lift coaches with drivers to transport the handicapped members 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 DUTIES UNDER THE NATIONAL ASSISTANCE ACT, 1948 Determination of Liability of the Local Authority The local authority in whose area a person is "ordinarily resident" is responsible for the cost of assistance provided by any other local authority (Section 32) subject to decision in cases of disagreement 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 as all cases in doubt have been amicably resolved. Registration and Inspection of Voluntary and Private Homes for the Aged and Infirm Local authorities are empowered (Section 26) to make use of accommodation for aged and infirm persons in homes established and maintained by voluntary organisations. The inspection and registration of such homes including establishments run privately is carried out under Section 37. 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. - 115 - At the 31st December, 1970, there were registered with the Council fifteen voluntary homes providing 728 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 The Council 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 (Section 48). As at 1st January, 1970, the property of 28 people was being stored, and in six instances houses and flats had been secured against unauthorised entry. During the year 140 (155) cases were dealt with. Relatives were traced and accepted responsibility in 35 cases. The property of 10 people was sent to the hospitals in which they were patients. Of the remainder, 29 patients' belongings were taken into store and 39 premises were secured (there being no moveable property). Of the total of 181 properties, 137 were satisfactorily resolved, and at 31st December, 1970, there remained one home under surveillance and the property of 43 people still remained under care and protection in store Burials and Cremations The duty is imposed on the Council 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 (Section 50). During the year under review, the Council became responsible for the burial of 54 (39) persons. The following is a summary of the action taken:- Cases where funeral expenses have been fully recovered 15 (19) Cases where part only of the expenses have been recovered 16 ( 6) Cases where full cost has been borne by the Council 23 (14) Cost of burials £1,741. 1s. 2d. (£1,115. 8s. Od.) Amount recovered £ 986.17s. 8d. (£ 600.13s„ 2d.) Net cost to the Council £ 754. 3s. 6d. (£ 5l4.l4s.10d.) In addition 30 burials or cremations were arranged as follows for persons resident in the Council's homes at the time of death: - 116 - Cases where funeral expenses have been fully recovered 18 (21) Cases where part only of the costs have been recovered 8 ( 7) Cases where the full cost has been borne by the Council 4 (17) Cost of burials £1,280. 0s. 6d. (£1,296.19s.0d.) Amount recovered £ 997.17s. 8d. (£ 901. 9s.6d.) Net cost to the Council £ 283. Os.lOd. (£ 395.10s.3d.) Settlement of Estates When a person dies for whom the local authority have been providing services arising from the National Assistance Act, 1948, they are required to arrange the settlement of the estate. This is carried out in consultation with the Treasury Solicitor. On 1st January, 1970. there were 39 estates outstanding. During the year 92 estates were referred for settlement and 87 estates were wound up involving receipts and payments of £3,922 and at 31st December, 1970, a total of 44 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. At 1st January, 1970, he was so acting in the cases of five persons. During the year one died and two new orders were taken, leaving a total of six Receivership cases with estimated value of £55,729.17s.2d., and for whom a total sum of £8,251. 1s. 3d., was disbursed during the year. Application for a Receivership Order has been made to the Court of Protection in one further instance. Removal to Suitable Premises of Persons in Need of Care and Attention The local authority is empowered to remove 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 (Section 47 and the National Assistance (Amendment) Act, 1951. ) Several cases were investigated during the year but it was only necessary to take action in the case of two women and two men. They were all admitted to King's Mead. TRAINING OF SOCIAL WORK STAFF Field Work Staff During the year there were two innovations in the field work section. A team clerk was attached to each of the three teams of, social welfare officers operating within the Borough. This has been a, very helpful development which has freed the social welfare officers from certain routine duties, thus giving them more opportunity to work directly with and on behalf of clients. - 117 - No member of staff was seconded for training in 1970, but two who where seconded in 1969 will be away for one further year. Two officers who completed qualifying social work courses returned to the Department during the year. Students from other Organisations Students from professional social work courses were received in the department as in previous years. Other students were also accepted in the department for short periods. In-Service Training and Development During 1970, a series of seminars was arranged to consider the implications of the reorganisation which will arise out of the Local Authority Social Services Act. Each seminar included officers from different social work sections of the department and by the end of the year most field work officers had participated in one of these seminars. Section 8 OTHER HEALTH SERVICES - 119 - OTHER HEALTH 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 1970, 2,272 calls were received by the Night Duty Officers, concerning this Council's services. NURSING HOMES There were no new registrations of nursing homes, but one home closed early in 1970 reducing the number of available medical beds by 15. During the year eight visits of inspection were made by a principal medical officer and the Chief Public Health Inspector. At three homes they were accompanied by an officer of the department of the Director of Technical Services, who inspected and advised on means of escape in case of fire. All homes are generally satisfactory, but at one the means of escape in case of fire were not considered to be adequate and various requirements have been made. Two visits were made to proposed nursing home premises and the prospective "keepers" were advised as to the suitability of the premises and the requirements that would have to be met before registration by the Council. Number of homes registered on 1st January 8 Number of registrations cancelled during the year 1 Number of homes remaining on the register at 31st December 7 Total number of beds at 31st December 187 Registered for medical patients only 142 Registered for medical or surgical patients 38 Registered for medical or maternity patients 7 Registered for surgical or maternity patients Nil Inspection by medical officer and/or public health inspector 8 - 120 - WATER SUPPLY The water supply in Kensington and Chelsea is almost entirely provided by the Metropolitan Water Board, but there are two 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 examinations, 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. Fluoridation Fluoridation of water supplies to a level of 1.0 part per million has been shown to be both harmless to health and most suited for the purpose of dental protection. This concentration of fluoride occurs naturally in many parts of the country, and artificial fluoridation in London is intended to make generally available the protection which is enjoyed by these other areas. The Council have agreed to support the general policy regarding fluoridation of water supplies, but no action has yet been taken by the Metropolitan Water Board to introduce the fluoridation of water in the London area. BACTERIOLOGICAL AND ANALYTICAL WORK During the year, arrangements were continued whereby specimens of milk, water and ice-cream for bacteriological examination were dealt with by the laboratory at County Hall, and all other specimens were sent to the laboratory at St. Stephen's Hospital. - 121 - The following table shows the total number of specimens examined by the two laboratories:- Nature of Sample Number Examined Nose and throat swabs 17 Faeces and rectal swabs 794 Urine 34 Milk (bacteriological) 48 Water (drinking) 19 Water (swimming) 58 Ice cream 36 Miscellaneous 27 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.I., 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 606 which included 128 cases in which there were inquests, PARKING CONTROL Applications for free parking facilities on grounds of physical disability are referred to the Medical Officer of Health for consideration and advice. If necessary, applicants are medically examined. During the year, 55 applications were received, 46 were granted and 9 were refused. STAFF MEDICAL EXAMINATIONS Prospective employees for some years have not been required to undergo a full medical examination before being admitted to the Superannuation Funds, but to complete a comprehensive questionnaire. Only where there is an element of doubt is the applicant medically examined. Number of questionnaires received 532 Number referred for medical examination 9 Number failing to pass 16 Number referred for further opinion 21 Number required to be re-examined within twelve months - In addition, 12 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. Six medical examinations were carried out at the request of other local authorities. INDEX Page Adoptions 22 Advice Leaflets 112 Amusements with Prizes - Permits 84 Area of Borough 9 Artificial Kidney Machines 33 Artificial Lighting of Common Staircases 71 Atmospheric Pollution - Clean Air 67-70 "At Risk" Register 23-24 Bacteriological and Analytical Work 120 Basement Bakehouses 73 Bathing Centre 47 BCG Vaccinations 36,48 Births 2, 9 Blindness 100 — 103,105 Boarding-Out of Children 23 Borough Co-ordinating Committee 43 Burials and Cremations 115 Care and Protection of Property 115 Care of Mothers and their Young 21 Causes of Deaths 12 — 13 Celluloid and Cinematographic Film - Registration for storage 84 Certificates of Disrepair 87 Cervical Cytology 25 Child Minders 22 Children "At Risk" 23-24 Chiropody 37,112 Chronically Sick and Disabled Persons Act, 1970 4 Clean Air Act 67 — 70 Clinics and Treatment Centres: Ante—natal 21 E.N.T. 47 Hearing 46,47 Minor Aliments 47 Special Investigation 47 Speech 47 Vision 46 Closing Orders 88 Community Care 55 Comparability Factors 9-10 Congenital Malformations 24-25 Consumer Protection Act 67 Coroner's Court 121 Creches 22 Page Day Nurseries 21-22 Deaths 2,9-13 Demolition Orders 88 Dental Health Education 51-52 Dental Service 51-54 Diphtheria 17 Diphtheria Immunisation 35 Discretionary Grants 88 Disease (Notification) 14-19 Diseases of Animals Act 66 Disinfection and Disinfestation 64 Domiciliary Midwifery 27 - 28 Domiciliary Welfare Services 99 - 100 Dysentery 14-19 Emergency Call Service 119 Employment Agencies & Nurses Agency Licences 84 Environmental Health Services 61-90 Estates, Settlement of 116 Factories and Workshops 71-73 Family Planning 25-26 Family Welfare Association 43 Fertilisers and Feeding Stuffs Act 66 Fireguards — Loan of 33 Fireworks - Registration for Storage and Sale 84 Fluoridation 120 Food and Drugs Act 79 -83 Food Poisoning 14 -19 Food Premises - Inspection and Registration 79 Food Sampling 80 Food Surrendered 80 Gaming Act, 1968 84 Grants and Loans 26 - 27, 32 - 33, 43 Greater London Council (General Powers) Act, 1968 78, 90 Handicapped and Elderly Persons 99 - 100, 106 - 109 Handicapped Children 23 - 24, 46 Health Centre Clubs 39 - 40 Health Committee 5 Health Education 3, 38 - 42 Health Education in Schools 40 Health Visiting 28 - 31 Holidays for Old People 1ll Home Help Service 33 - 34 Home Nursing 32 -33 Homeless Families 97 Homes for the Elderly 92-96 Hospital Admissions (Mentally Sub-normal) 55 Housing 85 - 89 Housing Priority on Medical Grounds 88 Page Ice-Cream 82-83 Illegitnnate Births 3,14 Immunisation and Vaccination 34-36, 48 Improvement Areas 85 Improvement Grants 3,86 Infant Mortality 3,9 Infectious Diseases 3, 14-19 Infectious Illness in Schools 49 In-Service Training 30, 117 Inspections and Supervision of Food Premises 79 International Certificates 19 Introduction 1-4 Kensington Day Centre Limited 114 Land Charges 77 Laundry Service for the Aged Incontinent 111 Legal Proceedings 88 Legal Proceedings in relation to Food Hygiene 89-90 Library Facilities for Old People 112 Licensing Act 77 Licences for Public Entertainment 78 Licensing and Registrations 84 Liquid Egg (Pasteurisation) Regulations 83 Loan of Home Nursing Equipment 33 Loans and Grants 26-27,32-33, 43 Malaria 14,19 Marriage Guidance 27 Massage Establishments 84 Mass Radiography 37 Maternal Deaths 3,10 Maternity and Child Health 21,3 - 54 Meals-on-Wheels 110 Measles Vaccination 35 Medical Examination of Staff 121 Medical Inspection at Schools 45 Medicinal Baths 64 Mental Health Service 55-59 Midwifery 27-28 Midwives Act 28 Milk 8l-82 Mortuary Facilities 121 Neonatal Deaths 3 Night Cafes 78 Noise Abatement Act 71 Notification of Congenital Malformations 24-25 Notification of Diseases 14-19 Nottinghill Neighbourhood Service 57 Nurseries 21-22 Nursing Homes 119 Nursery Nursing Staff 21 Page Obstetric Nurse Training 28 Occasional Creches 22 Officers of the Health and Welfare Services 6-7 Offices, Shops and Railway Premises Act 74-77 Oil Heaters 67 Old People's Welfare 110 - 114 Ophthalmia Neonatorum 14-19 Other Health Services 112 - 121 Outwork 73 Overcrowding 87-89 Parking Control 121 Partially Sighted Persons 104 - 106 Personal Cleansing 64 Personal Health Services 21-44 Personal Hygiene in Schools 47 Pet Animals Act 67 Pharmacy and Poisons Act 66 Play Groups 22 Poliomyelitis 14-19 Poliomyelitis Vaccination 34 Population 2,9 Prof ace 1—4 Prevention of Damage by Pests Act 65 Prevention of Illness, Care and After-Care 37-42 Psychiatric Day Centre 56 Psychiatric Social Club 56 Psychoprophylaxis Classes 41 Qualifiaction Certificates 85 Rag Flock and Other Filling Materials Act 66-67 Rateable Value 9 Rats and Mice 65 Receiverships 116 Recuperative Holidays 38 Registration of Food Premises 79 Registration & Inspection of Voluntary & Private Homes for the Aged and Infirm 114 - 115 Remedial Foot Classes 48 Removal of Persons in Need of Care and Attention 116 Residential Accommodation for the Elderly 92-96 Residential Care of the Mentally Sub-normal 55 Riding Establishments Act 66 Rodent Control 65 Rubella Vaccination 36 Sanitary Inspection 6l-63 Scabies 64 School Health Service 45-49 Screening Tests of Vision and Hearing 46-47 Settlement of Estates 116 Slaughterhouses 83 Smallpox 14-19 Smallpox Vaccination 35 Page Smoke Control Areas 67-70 Social and Rehabilitation Centre, Social Activities 111 - 113 Staff 6-7 Standard Grants 88 Statistics - Dental Health 52-54 Environmental Health 61-90 Mental Health 55-39 Personal Health 21-44 School Health 43-49 Vital and Social 2, 9 -19 Welfare 91-117 Stillbirths 9 Students 117 Sub-normal Children 56 Suicide 10, 13 Surrender of Unfit Food 80 Swimming Baths 120 Talks to Groups 4l — 42 Task Force 112 Temporary Accommodation 92, 97 - 99 Tetanus Immunisation 35 Theatrical Employers - Registration 84 Town Planning Applications 77 Training Centres for the Mentally III 56-57 Training of Pupil Midwives 28 Training of Social Work Staff 116 - 117 Transport of Handicapped Persons 109 Tuberculosis - Care and After-Care 18-19 Notifications, deaths, etc 18-19 Vaccination 36 Visiting 18 Unclean Milk Containers 82 Unmarried Mother and her Child 26 Unfit House and Parts of Houses 87-88 Unsound Food 80 Vaccination and Immunisation 34-36 Venereal Disease 44 Vital Statistics 2,9- 19 Voluntary Homes for the Aged and Infirm 96 Voluntary Visiting of the Elderly 113 - 114 Water Supply 120 Welfare Services 4, 91 117 Welfare Committee 3 Welfare Grants to Voluntary Organisations 100 West London Family Service Unit 43 Whooping Cough Immunisation 35 X—ray Units 37