NEWH 1 LONDON BOROUGH OF NEWHAM PUBLIC HEALTH IN NEWHAM 1965 - 1970 PUBLIC HEALTH IN NEWHAM 1965 - 1970 The Report of the Medical Officer of Health and Principal School Medical Officer for the period 1965-1970. N.S. Galbraith, M.B., F.F.C.M., D.P.H., Health Department, 99, The Grove, Stratford, E.15. LONDON BOROUGH OF NEWHAM With the Compliments of the Medical Officer of Health and Principal School Medical Officer. 99, The Grove, Stratford, London, E.15. 01-534 4545 CONTENTS Page Health Committee 2 Introductory 3 Staff 4 Part I Vital Statistics 6 II Infectious Diseases 8 III Personal Health Services 14 IV Child Health Services 24 V Mental Health Services 32 VI Environmental Health Services 38 VII Appendix of Statistical Tables 44 Index 64 1 MEMBERSHIP OF NEWHAM HEALTH COMMITTEE 1965-1970 CHAIRMAN: Name Year of Office Alderman Mrs. M. Scott, J.P. 1965, 1966, 1967, 1968, 1969, 1970 Members Councillor Mr. R.P. Anderson 1968, 1969, 1970 Councillor Mrs. G.L. Bendal 1968, 1969, 1970 Councillor Miss W.M. Cross (Deceased 20th July, 1967) 1965, 1966, 1967 Councillor Mr. E. Daly 1968, 1969, 1970 Councillor Mr. M. Davidson 1968, 1969, 1970 Councillor Mrs. E.M. Devenay 1965, 1966, 1967 Councillor Mr. H.W. Doran 1968, 1969, 1970 Councillor Mr. S.A. Elson 1965, 1966, 1967 Councillor Mr. H.J. Fisher 1965, 1966, 1967, 1968, 1969 Alderman Mrs. A.E. Gannon 1966, 1967, 1968, 1969, 1970 Councillor Miss J.E. Griffin 1968, 1969, 1970 Councillor Mrs. M.E. Helps 1965, 1966, 1967 Councillor Mr. J.W.F. Hucker 1968 Councillor Mr. W.E. Hurford 1965, 1966, 1967 Councillor Mr. E.S.C. Kebbell 1965, 1966, 1967 Alderman Mr. J.A. Kemp 1968, 1969, 1970 Councillor Mr. J.R. Kent 1965, 1966, 1967 Councillor Mrs. J.M. King 1968, 1969, 1970 Councillor Mrs. W.M. Knight, O.B.E. 1965 Councillor Miss M. Lay 1969, 1970 Councillor Mr. D.W. Lee 1966, 1967 Councillor Mr. S.G. Ling 1966, 1967 Councillor Mr. A. Macfarlane 1968, 1969, 1970 Councillor Mr. T.W. Miller 1968, 1969, 1970 Councillor Mr. F.P. Penfold 1968, 1969, 1970 Councillor Mrs. C.L. Retter 1968, 1969, 1970 Councillor Dr. R. Rees 1965, 1966, 1967 Alderman Mr. L.J. Simons 1970 Councillor Mr. J. Taylor 1970 Councillor Mr. F.G. White 1965, 1966, 1967 Councillor Mr. E. Wren 1965, 1966, 1967 2 Health Department, 99, The Grove, Stratford, El5 1HR To: The Mayor, Aldermen and Councillors of the London Borough of Newham Mr. Mayor, Ladies and Gentlemen, It is my pleasure to present a report on the health of the borough for the period 1965-1970. On 1st April, 1965, the London Borough of Newham came into being and the Council can, I am sure, look back with some satisfaction on the successful integration of the services run by the two former County Boroughs and the progress made during the years under review. As you will be aware, during the period covered by this report, the department was administered by my predecessor, Dr. F.R. Dennison who was appointed in January, 1971 as our Director of Social Services. I would like to take this opportunity to thank the staff of the Health Department for their loyalty and sustained effort during what was a very busy and difficult period. I am sure they will join me in my thanks to the Health Committee for their support and encouragement and in particular to the Chairman, Alderman Mrs. M. Scott, whose enthusiasm and understanding for our work was much appreciated. I am, Yours faithfully, N.S. Galbraith Medical Officer of Health & Principal School Medical Officer 3 Senior Staff of Health Department (as at 31st December, 1970) Medical Officer of Health F.R. Dennison M.D.,D.P.H. Deputy Medical Officer of Health Dr. N.S. Galbraith Principal Medical Officer Dr. R. Jacobs Senior Medical Officers Dr. R. Clay Dr. J. Bean Dr. M.P. O'Dwyer Psychiatrists Dr. J.H. Kahn Dr. J. Swift Principal Mental Health Social Worker Miss E.M. Thomson Senior Mental Health Social Workers Miss M.E. Richards Mr. P. Hickson Chief Dental Officer Mr. P. Chandler Senior Dental Officers R. Batty J. Kelly K. Kumar Chief Public Health Inspector Mr. E.R.H. Hodge Deputy Chief Public Health Inspector Mr. J. Clarke Senior Public Health Inspectors Mr. J.A. Orrell Mr. L. Joyce Principal Nursing Officer Mrs. M. Gannon Superintendent Health Visitor Non-Medical Supervisor of Midwives Miss J. Watt Miss M. Blackwell Chief Chiropodist Physiotherapist Speech Therapist Mr. D. Beaton Mrs. A. Tootell Miss A. Clarke Chief Administrative Officer Mr. G.D.H. Brown Deputy Chief Administrative Officer Mr. S.J. Adams 4 PART I VITAL STATISTICS 5 6 VITAL STATISTICS In April 1965 the County Boroughs of West Ham and East Ham, merged to form the London Borough of Newham, one of the 32 London Boroughs created by the reorganisation of the Local Government structure in London. The Borough of Newham is bounded on the south-side by the River Thames, on the west by the Borough of Tower Hamlets, on the east by the Borough of Barking and to the north by the Boroughs of Waltham Forest and Redbridge. The Borough is approximately 4¾ miles long by 4½ miles wide at the most distant points and covers an area of 8,986 acres, of which 1,000 acres are occupied by the Royal Group of Docks. The mileage of road covered is 214.67. Newham is both industrial and residential in character. The docks and heavy industry tending to concentrate in the south and west and light industry and residential areas in the north and east. Population In 1965 the population of the Borough was 260,070 and 1970 was 247,170, a decrease of 12,900. This is a continuation of a downward trend; the Registrar General's returns show a figure of 293,700 in 1950 and 272,470 in 1960. The density of population in 1970 was 27.5 per acre, a reduction of 4.9 persons per acre since 1965. Summary of Statistics BIRTHS 1965 1966 1967 1968 1969 1970 All births 5216 5307 5076 4866 4582 4409 Live births 5112 5219 4999 4781 4509 4338 Still births 104 88 77 85 73 71 DEATHS 1965 1966 1967 1968 1969 1970 All causes 2879 2887 2708 2896 2933 2721 Maternal 8 3 3 2 1 2 Infants under 1 year 103 99 97 114 86 90 Detailed statistics including rates per 1000 are given in the Tables on page 46. 7 PART II INFECTIOUS DISEASES 8 INFECTIOUS DISEASES NOTIFIABLE INFECTIOUS DISEASES Statistics of notifiable infectious diseases are given in Table E on page 48. ANTHRAX A very unusual incident occurred in 1965 in which contaminated second-hand sacks appeared to be the source of infection in a case of pulmonary anthrax. A 54-year old Jamaican employed as a grinding machine operator developed pulmonary anthrax and died within two days. In the eight days before the onset of the illness he had been grinding sterilised bone charcoal which had been delivered to the factory in second-hand sacks. Some of these sacks had been used to import raw bone before its sterilisation and Bacillus anthracis was isolated from four out of six sacks examined, (British Journal of Industrial Medicine 1968). The contaminated sacks were destroyed ahd sterile paper sacks have since been in use. BRUCELLOSIS An outbreak of seven cases of Brucella melitensis infection (Mediterranean fever) took place in 1965 in persons of Italian origin resident in the Borough. The infection was traced to Pecorino cheese which had been purchased in a village market in central Italy (British Medical Journal 8th March, 1969). All seven patients recovered satisfactorily after treatment. DIPHTHERIA No cases of diphtheria were notified during the years 1965-1970, although the Medical Officer of Health was informed of five suspected cases. Isolation of the suspected case, immunisation and collection of nose and throat swabs from immediate contacts was instituted in each instance. All the suspected cases proved to be suffering from infectious mononucleosis. One carrier of a diphtheria organism in a school child was reported. Immunisation and examination of the school and home contacts was carried out. Laboratory tests subsequently showed the strain of organism to be non-pathogenic. FOOD POISONING Over 400 cases of suspected food poisoning were investigated by the Public Health Inspectors during the six years under review. There were 58 cases of salmonella infection. Four of these due to Salmonella brandenburg comprised a small outbreak in a maternity unit. Ten were due to S.panama and formed part of a widespread outbreak in East London and Essex traced to cooked ham, and four due to S.enteritidis were part of an outbreak at a wedding reception in a neighbouring borough. There were 17 cases of staphylococcal food poisoning, 13 of which comprised an outbreak in a hospital ward. This was traced to a food handler suffering from external otitis. 9 There were two cases of Clostridium welchii food poisoning. The remaining 423 of the 500 cases of suspected food poisoning were not shown to be infected with food poisoning organisms. INFECTIVE JAUNDICE This was made notifiable on 1st July, 1968. In the first full year of notification, 1969, there were 62 cases; in 1970 there were 111 cases. It is likely that this increase was due to improved notification, but the 1970 figure still probably considerably underestimates the total number of cases in the community. It was not possible to carry out detailed investigation of cases because of shortage of medical staff, but a study of the age distribution of cases did not suggest syringe transmission or food borne infection. No outbreaks came to notice but on several occasions schools were advised on special hygiene measures because one or more pupils were known to be suffering from infective hepatitis. MALARIA Two cases of malaria occurred in 1970 in adults recently arrived from overseas who were infected abroad with Plasmodium vivax (Benign tertian) malaria. MEASLES Notifications of measles declined in the period under review following the introduction of vaccination against measles in 1968. This decline is very similar to that experienced nationally. In 1968 a year in which a low incidence of measles would normally have been expected only 375 cases were notified, about 2/3rds reduction. In 1969 a high incidence year, the notifications were about half that which would be expected without immunisation. In 1970 the notifications doubled compared with 1968 but were still less than before immunisation. The increase in this year, however, emphasises the importance of reaching and maintaining a high immunisation rate in all children under 15-years. In 1970 less than 25% of children aged 15-months had received the recommended measles vaccination. It is unlikely that the disease will be controlled in the Borough until this figure reaches 80-90%. POLIOMYELITIS One case of paralytic poliomyelitis due to Type 2 virus occurred in a 15-year old un-immunised boy in 1970. This was the first case in the area for over ten years. The source of infection was not discovered but the disease may have been contracted by accidental immersion in a sewage polluted river. Close contacts of the boy were examined and immunised; no further cases occurred. Blood samples from 247 Newham school children were examined for immunity to poliomyelitis (Lancet, 11th October, 1969). Because 13% of them had a low immunity to the main epidemic type of polio virus a booster dose of vaccine is now offered at the same time as B.C.G. vaccination in school at the age of 12-13 years (British Medical Journal, 24th April, 1971). 10 SMALLPOX No cases of smallpox occurred in the Borough during 1965-1970 although eight suspected cases were seen by the Medical Officer of Health. One of them was a child with mild eczema vaccinatum. Six of them were suffering from chicken pox and one an abnormal vaccingtion reaction. This last case was a Pakistani child of 6-months who arrived with his mother from Karachi by air on l8th December, 1968. The child had been vaccinated in Pakistan on 9th December. He developed a rash on the forehead on 17th December which had spread to involve his face, arms and legs by 20th December. The rash appeared typical of modified smallpox and the child was admitted to Long Reach Smallpox Hospital. All close contacts were traced, vaccinated and placed under surveillance. Repeated laboratory tests for smallpox virus proved negative, the child's rash did not progress and he was allowed home on the evening of the 24th December, when the diagnosis of smallpox had finally been disproved. TUBERCULOSIS Tuberculosis continued to decline in the Borough although there was a slight increase in non-respiratory types of the disease. All cases were fully investigated at the local Chest Clinics and Hospitals and their contacts followed-up by Health Visiting staff. Extensive investigations were undertaken in association with Number 6b Mass X-Ray Unit at two bakeries, one clothing factory and a canning factory where single cases of tuberculosis had occurred. No additional cases were found. There were five separate cases of adult type pulmonary tuberculosis in secondary school children which necessitated detailed investigation in the five schools concerned. In all cases the infection had been acquired in the home and no evidence of spread of infection in school was found. Because of these cases in schools, increased publicity was given to B.C.G. vaccination in schools. B.C.G. vaccination was given to all Heaf negative children and after 1969, also to those who were Heaf Grade 1 (Lancet, 6th September, 1969). In 1970 the age of vaccination was reduced from 13 to 12 years. Statistics are given in Table Q on page 58. Special attention was given to the problem of tuberculosis in Asians in whom the disease may spread more readily. In association with Asian community leaders publicity was given to the need for regular chest x-rays of Asian adults and for the B.C.G. vaccination of children. Whenever possible Asian children were offered B.C.G. vaccination at birth or on arrival in this country. TYPHOID FEVER AND PARATYPHOID FEVER Four cases of typhoid fever and three carriers were recorded. One of the cases was infected in Spain, but the sources of infection in the other three were not ascertained. There was no relationship between these cases. Two were in West Indians and one in an Indian, all of whom had been resident in the United "Kingdom for several years. Two of the carriers came to notice as a result of investigation in Hospital for unrelated symptoms and one was reported by a neighbouring borough as having been known for several years. 11 Two oases of paratyphoid fever were notified. One of paratyphoid A in a visiting Indian seaman with a bone abscess and the other paratyphoid B in a child aged 4 years thought to have been infected in Spain. VENEREAL DISEASE A special Clinic for the diagnosis and treatment of sexually transmitted diseases is held at Queen Mary's Hospital, Stratford, E.15., to whom I am indebted for the following statistics: Newham Residents 1965 1966 1967 1968 1969 1970 All attendances 4l6 419 518 551 540 689 All Patients 1965 1966 1967 1268 1969 1970 Syphilis 38 33 29 12 18 17 Gonorrhoea 130 101 133 123 131 170 Other conditions 554 618 684 788 852 1012 Syphilis has continued to decline, but there has been an increase in Gonorrhoea corresponding to the national trend. Increased attendances at the clinic indicate that more patients are seeking advice, many of whom are found to be free from infection. WHOOPING COUGH The increase in whooping cough notifications between 1965 and 1967 was part of a national trend. Although the cause was not ascertained it was believed that it was due to the appearance of a new strain or organism against which the vaccines then in use were not fully effective. A new modified vaccine has been in use since 1968. A decline in notifications took place that year and in 1969, although there was a rise again in 1970. In 1968, the new schedule of immunisations recommended by the Department of Health was introduced in Newham. Triple antigen (diphtheria/tetanus/pertussis vaccine) is now offered at 4, 6 and 12 months of age with a booster dose of diphtheria/tetanus vaccine at school entry. Oral poliomyelitis vaccine is given at the same time. The proportion of Newham children receiving the primary course of three doses of vaccine is between 80% and 85%. 12 PART III PERSONAL HEALTH SERVICES 13 14 PERSONAL HEALTH SERVICES The Principal Nursing Officer, Mrs. M. Gannon, reports as follows:- Health Visiting Service "In 1965 when the London Borough of Newham was formed by the amalgamation of the CountyBoroughs of East and West Ham, the health visiting establishment was 79. The Borough was divided into 52 health visiting areas, two of which were general practitioner attachment areas. The remainder of the establishment consisted of state registered nurses and state enrolled nurses. Two new commitments were taken on by the service in the period under review. Firstly, in late 1965, the health visitors were made responsible for convalescence, and secondly, in May 1966, the Principal Nursing Officer was made responsible for the organisation and social casework for the unmarried mothers. In 1966, three Group Advisers were appointed with special responsibilities in three fields:- (1) Co-ordination of the work in the schools for educationally sub-normal pupils, day training centres and development clinics. (2) Co-ordination of audiology services and hearing screening tests. (3) Co-ordination of geriatric liaison and social case-work for convalescents. Each Group Adviser was responsible also for care of about 90 families and was given charge of health visiting staff and clinic premises. In 1967 a Fourth Group Adviser was appointed to be responsible for the social casework for unmarried mothers. In 1969 a fifth Group Adviser was appointed for health education. This member of staff has now resigned and the post remains vacant. Prior to 1967 in the School Health Service, public health nurses assisted health visitors in their school and clinical work. In 1967 the practical work in schools was delegated to public health nurses with a health visitor remaining in ultimate responsibility and the role of the public health nurse clearly defined. In 1967 the first male Health Visiting Officer was appointed in this Borough and allocated duties with problem families and health education. After a period of nine months his method of working was found to be too restricted and not using the full range of health visitor skills. He was then transferred to the normal range of health visitor duties, maintaining his interest in health education and this proved to be so successful that three more malehealth visiting officers were appointed. One subsequently resigned. In accordance with the policy of the Council for the training of health visitors, four health visitors have been trained as field work instructors. After a period of one year, one of the health visitors decided not to continue as a field work instructor and another is now working part-time, no longer in the post of field work instructor. 15 The 1968 amendment of the Nurseries and Child Minders Regulations Act, 1948 greatlyincreased the volume of work involved in the day care of children. Towards the end of 1969, a Senior Nursing Officer was appointed to be responsible for the organisation and supervision of this work. Playgroups have been established in four of the local authority clinic centres. A trained nursery nurse is in charge of each playgroup with a paid assistant to help her. Voluntary helpers are encouraged to take an active part in these playgroups. In 1965 two full-time health visitors were attached to general practitioners. One in a two doctor practice and the other in a group practice of three doctors. There are seven health visitors who have an established liaison with general practitioners, mostly group practices. Four of these health visitors have weekly baby clinics held at the surgery and the other three meet the doctors weekly to discuss problems of families on their areas. They also act as liaison workers between their health visitor colleagues and general practitioners. In September 1968 after much discussion with all members of the staff involved, a new concept of child health sessions came into being. A doctor and health visitor work together to carry out the developmental assessment of each child in certain age groups. Each health visitor retained her personal interview session, thus making more demands on the health visitor's time. Appointments are arranged according to health visitor areas so that the social background of the family is known at the time of assessment. All health visitors find this work more meaningful and the service is appreciated by the parents of the young children. Liaison work between local authority and hospital services has increased. Eight health visitors visit the local maternity hospital wards and interview all new ante natal patients at the clinics. Four health visitors are involved in weekly liaison with local hospital paediatric clinics. One health visitor is in attendance at the hospital diabetic clinic twice weekly, one of the clinics being held in the evening. There is a team of four involved in this work, and follow-up visits are made by the health visitors whenever necessary. One health visitor visits the local geriatric unit weekly. All of these health visitors work in close liaison with their own colleagues and are responsible for obtaining any specialist's reports required. One male health visiting officer is in attendance at one of the local V.D. clinics and is responsible for male contact tracing. Altogether, there are four full-time and three part-time members of nursing staff working in the two chest clinics. In one chest clinic the local authority staff of one health visitor, one tuberculosis visitor and two public health nurses, share the combined duties of the Regional Hospital Board and the local authority. In the other chest clinic, the Regional Hospital Board's responsibilities are carried out by their own nursing staff and local authority work by two health visitors and one public health nurse. Chest clinic staff work in close liaison with their health visitor colleagues. Day Nurseries The authority has two day-nurseries with fifty two children in each. Both are recognised as training centres for nursery nurse students, linked with the West Ham College of Further Education. Staffing has, at times, proved difficult due to many factors common to other services in this authority. The intake of students has been maintained, but there has been a high wastage. The policy of admission to the nursery has been the usual priority categories. Children with a slight handicap have also been admitted to help the parent and child and to assist the medical officer assessing the child's need in care and attention. 16 Following the granting of urban aid to the authority, to enable development of certain services, planning commenced in 1969 for the building of two new day nurseries. Negotiations are in progress for a further four nurseries. In the plans of the first two nurseries accommodation has been designed for a handicapped baby unit, and in the light of experience, other similar projects may evolve. Statistics are given in Table M on page 54. Child Minders By 1970 there was a total of 105 Registered Child Minders. Health visitors continued their work in inspection and supervision throughout this period in an effort to maintain a satisfactory standard and to check on any changes in staffing and attendance. (See Table M on page 54. District Nursing Service General practitioner attachment of district nurses was extended in July 1967 to include all practices in the borough. This arrangement has been facilitated by the grouping of doctors and by improved general practice premises. More nurses are now working in doctor's surgeries and there are plans to develop this further. Patients, nurses and doctors have all commented on the improved service which has resulted from this integration of the district nursing and general practitioner services. Skilled nursing time has been better used by employing nursing attendants under the supervision of State Registered Nurses for some of the less skilled tasks and by the use of pre-packed, sterilized, disposable equipment and dressings. Liaison with hospitals has been improved. There has been an extension of the arrangements previously made for secondment to psychiatric hospitals of district nurses to include secondment to medical rehabilitation centres. Nurses have also been seconded part-time to local general hospitals. The School of Community Nursing was opened in September 1966. Regular training courses in District Nursing for State Registered Nurses and State Enrolled Nurses have been provided. A complete report of the work of this school is given under a separate heading. Many staff have been involved in practical training of students from the nursing school. Nurses have also been responsible for demonstrating domicilliary care to nurses from hospitals and to other groups of workers. Recruitment of district nurses has been fairly satisfactory. The District Nursing Service is one of the main areas of growth in the Health Services at the present time and further staff will be required in the future to undertake the increasing home care of patients. Midwifery Service There were about 5,000 deliveries each year in the borough between 1965 and 1970. The number of home deliveries during this period decreased to about 400 per year and the number of early discharges from hospital increased to about 600 per year. 17 The twelve domicilliary midwives all attended special courses in accordance with the statutory requirements of the Central Midwives Board. In addition one attended a residential school on parent craft. Seven of the twelve domicilliary midwives are approved as training midwives. Newham normally receives fourteen pupils each three months from Forest date Hospital for the domicilliary training. Since 1969 this has included a programme of visits and lectures on all aspects of community care in accordance with the recommendations and with the approval of the midwives board. New developments in equipment have been the provision of Entonox and apparatus and Blease Sampson neo-natal resuscitators to all the midwives. As in the District Nursing Service there has been an increase in the range and use of disposable equipment. Since 1969 the domicilliary midwives have collected blood specimens for Guthrie tests for phenylketonuria from all babies living in the borough who are either born at home or discharged from hospital before the tests can be carried out. They have also been responsible for carrying out the repeat test when the test carried out in hospital has proved unsatisfactory. Ante Natal Clinics The position of local authority ante natal clinics in Newham reflects the general trend in development in the field of obstetric care in this country. Owing to the increasing interest in assumption of responsibility for ante natal care by general practitioners and general practitioner obstetricians, the number of attendances in the local authority ante natal clinics has gradually decreased. Accordingly, the number of ante natal sessions has been reduced. There were 9,519 attendances at 6ll sessions in 1965, compared with 4,382 attendances at 428 sessions in 1970. Statistics are given in Table F on page In two centres on the east side of the borough, there are general practitioner obstetrician sessions in local authority premises, assisted by local authority staff. The doctors see not only cases for home confinement but also expectant mothers referred by hospitals for intermediate care. On the west side of the borough some of the general practitioner obstetricians attend local authority clinics with their domicilliary midwives to examine together the women booked by them for home confinement. All expectant mothers visiting the local authority centres for the first time are advised to see their general practitioner and to ask their advice where they should seek ante natal care. They are given an appropriate letter explaining to the general practitioner the existing facilities in the borough, asking them to indicate their preference." 18 NEWHAM SCHOOL OF COMMUNITY NURSING Newham's school is situated in self-contained premises at Ravenhill Road, shared with a group of District Nurses using it as a working base. The first course for District Nurse training began in September 1966 and all the eight nurses attending obtained certificates. In the Spring of 1967. a course was begun for State Enrolled Nurses. This was followed in early summer by the first refresher course which was attended by students from Newham and other local authorities. These were the school's first external students. At this refresher course a policy was established and since adhered to, of presenting a smaller number of topics in depth, rather than aiming to achieve superficial cover for the maximum number of topics possible. In the Autumn of 1967. a course for nursing attendants was offered. This has been repeated at intervals since and students who satisfactorily complete the course, including a simple practical assessment, receive a Newham certificate. In 1968, it was decided to award a Newham certificate of District Training to State Enrolled Nurses, rather than to train them under the auspices of the Queen's Institute. At this time the school took the controversial step of making some of this training for the Enrolled Nurse a shared one with the State Registered Nurse. Criticised, as this was at the time, it is gratifying that this has now become official policy of the Department of Health as laid down in Circular 8/70. Later the Queen's Institute relinquished the training of State Registered Nurses for the district, and this training became the responsibility of the Department of Health and Social Security. Early 1968 saw the beginning of the District part of the London Hospital's State Enrolment District Nursing Integrated Training Scheme. In the Autumn, the school ran a three-day course on 'Preparation for Attachment'. This was attended entirely by outside students, as Newham's field Staff were already settled into attachment schemes. In June 1970, the school arranged a course for Practical Work Instructors, which was attended by external students, as well as students from Newham's District Nursing and Midwifery Services A certificate was awarded on the basis of assessment of suitability and a very taxing practical assignment. As the school has developed, its educational patterns have changed a good deal. Specialist lecturers are still used, but these now tend to come, mostly from the fields of general practice and public health and welfare, rather than from hospitals. Much more use is now being made of tape-recordings followed by structured seminars. The tendency is also, to make fewer visits of observation, and those that are made to be tied into the teaching pattern much more closely. A change has been made in the traditional examination system, consisting as it did of a written paper and a session 'out on the district' with an external examiner. The written paper remains, probably because students have been conditioned to accept this, but the nursing round has been replaced in Newham, for State Registered Nurses, by a combination of a viva by an external examiner, based on two case studies together with an on-going assessment. This has amply justified itself. The department's new arrangements for examining the State Enrolled Nurse for the National Certificate have replaced the nursing round with an on-going assessment. 19 Family Planning In the period under review the Council's Health Department became increasingly concerned with the provision of Family Planning Services in the borough. Family Planning Clinics run by the Family Planning Association were established at five centres in the borough, three of them in Health Department Clinics provided, without charge, for this purpose. A standard charge to patients for consultation is made together with the cost of prescriptions. Newham residents attending these clinics and who have special medical or social needs, were provided with a completely free service on the recommendation of one of the Council's medical officers. In 1966 a free domicilliary family planning service was established by the Council which has continued to expand since. Newham residents are visited by the Family Planning team on the receipt of a recommendation from the Council's Health Visitors or Mediecal Officers. Under the National Health Service (Family Planning) Act, 1967 the Council approved the provision of a free family planning consultation service for all Newham residents but the implementation of this policy was postponed because of financial stringency. Cervical Cytology A report was submitted to the Health Committee in July 1965 on arrangements for carrying out tests for the early detection of cervical cancer, commencing with two clinic sessions per week. This was soon extended to four sessions and by the end of 1965. 508 women had been tested, either following recommendation from their general practitioners or by personal request. Since 1966 about 2,000 tests a year have been carried out. In 1970 the Women's National Cancer Control Campaign loaned to the Health Department a specially fitted caravan which visited factory premises in the borough. Over 400 women were examined. Further visits to local factories and shops have since been arranged, making use of medical room facilities provided on their premises. Special thanks are due to Dr. Hannah Barnet of Lewisham Hospital and to Dr. Richard Alexander of Queen Mary's Hospital and their laboratory staff for their share in this work, without which the scheme would not have been possible. Chiropody The Chiropody Service was inaugurated by the Old People's Welfare Committee of the former County Borough of West Ham in November 1956 and the Council assumed financial control in September 1961. On 1st April, 1965, the entire Service became the responsibility of the London Borough of Newham, and Clinics were opened for the first time on the east side of the Borough. At present seven Clinics are operated, together with domiciliary services. We have been very fortunate in having a specially built Chiropody Clinic provided in the new Lawrence Hall by Aston Charities which has allowed us to open an Appliance Section and make fuller use of a mini-bus service to collect patients who otherwise would have to rely on the domiciliary service. 20 Domestic Help Service The Council is empowered under Section 13 of the Health Services and Public Health Acts, 1968, to provide domestic assistance during emergencies such as confinements or illness, and to assist aged persons who are unable to fend for themselves. The heaviest demand continued to be from the latter category. There were the equivalent of 330 full time Home Helps employed by the Council at the end of 1970. During the period under review there was a standard charge of 50p per hour which was reduced according to the financial circumstances of the person assisted. The service was free to those persons in receipt of supplementary benefits. In 1970 Home Help Service was provided to 3,836 residents, an increase of 609 over the 1965 figure. Visits were usually made two or three times weekly, it was rarely possible to provide a daily service because of the large demand for the service in the Borough, Undoubtedly this is one of the most important services provided for elderly persons in their homes in Newham and further expansion is anticipated when financial stringency permits. Statistics are given in Table L on page 54. Home Renal Dialysis When the Ministry of Health Circular 2/68 was published early in 1968, making it the duty of Local Authorities to carry out conversions to houses for the installation of Renal Dialysis Units, there were already two Units operating in Newham. The first of these had been sponsored privately and started operating early in 1967 and the second had been installed jointly by the Hospital and the Welfare Department becoming operational in November 1967. The first of the conversions carried out by the Health Department. commenced in June 1968, but owing to serious difficulties encounteredwith the structure of the building and the pressure of the water supply, the artificial kidney could not be connected until March 1969. Subsequently five more machines were installed in the Borough up to mid-1971 and of the total eight machines, five were in private houses and three in specially adapted Council dwellings. Of the original eight patients, two have died, and there are now six machines operating in the Borough. The average cost of conversion to date was approximately £600 but this figure is not truly representative as in one case where it was necessary to build a new first floor back addition to house the machine, the eventual cost was much higher. Removal of Persons in need of care and attention The Council is empowered under the National Assistance Act, 1948, Section 47 as amended by the National Assistance (Amendment) Act, 1951 to make application to a Court of Summary Jurisdiction for an Order for the removal to a Hospital or Institution of any aged, infirm or physically incapacitated person living in insanitary conditions and who is in need of care and attention. It was found necessary to apply for two removal orders in 1965, four in 1966, six in 1967, seven in 1968, one in 1969 and three in 1970. 21 Health Education Health education involved many of the Health Department staff but particularly health visitors. They have undertaken individual and group teaching of expectant and nursing mothers, they have assisted teachers in health education in Schools and arranged special lectures and displays. Public Health Inspectors have continued to provide health education on food hygiene throughout the Borough. They have given lectures and special courses for Schools Meals Service and other catering staff. Special publicity campaigns were promoted on immunisation, cervical smear tests, accidents in the home, food hygiene and cigarette smoking. Laundry Service Soiled bed linen and personal clothing was collected regularly from the homes of those persons who were incontinent and laundered in the Council's Baths Department Laundry. Consideration was given to the suggestion that disposable incontinence pads should be provided to all those in need on request. It was thought, however, that difficulties in disposing of these pads in this area was outweighed by the advantages of the Service and it was, therefore, decided to continue the incontinent laundry service instead. A small supply of incontinence pads was made available to Home Nurses for use in cases of emergency. Loan of Nursing Equipment Articles of sick room equipment were issued on short term loan free of charge at the request of general practitioners, district nurses and other workers to persons being nursed in their own homes. The Health Department have a stock of over 196 wheelchairs and 233 commodes and many items of smaller equipment. The demand for short term loan of these two main items has been difficult to meet at all times during the period under review. In 1969. an appeal was made via the Council's News-sheet for unwanted items of nursing equipment, particularly wheelchairs. The Department was very grateful for the response and in particular to the East Ham Round Table No. 4l6 who generously donated £171, which was used to purchase additional wheelchairs. 22 PART IV CHILD HEALTH SERVICES 23 24 CHILD HEALTH SERVICES The Principal Medical Officer, Dr. R. Jacobs, reports as follows "The Child Health Services in the two former Boroughs of East and West Ham differed and a common policy had to be worked out, It was decided to develop a new pattern of Child Health Services retaining the best features of the previous services and geared to the needs of the new Borough taking into account modern trends and ideas. The science of developmental paediatrics with its emphasis on continuous assessment of children from birth up to school leaving age, has transformed the service from a defect and treatment orientated one, to one of assessment of all children. Although many basic principles of developmental paediatrics were applied in previous years, we have pursued during the past five years a more systematic and deliberate policy of bringing the organisation of the Child Health Services quite up to date. Despite the limitations imposed by financial stringency wide opportunities were offered to all grades of staff to gain further experience and training in the field of developmental paediatrics and mental assessment by attending appropriate courses and in-service training. Records of congenital malformations observed at birth were kept since 1964, as requested by the Ministry of Health. In 1962 the Borough introduced a register of handicapped children and those at risk of a handicapping condition. The list of conditions placing the child in the risk category has been under review and modified, and in February 1969 the Oppe classification was introduced. We came to the conclusion that we should try and assess all children in the Borough by offering appointments in our Child Health Centres and to arrange special follow-up through health visitor home "visits, of only those children who have failed to attend for assessment. Having taken into consideration the number of medical officers and health visitors available for this work, and their other duties, we have decided to see children by appointment at least four times in the pre-school period. The recommended ages were four weeks, nine months, 2½-years and 4-years, In order to cover all the children in the available sessions with the available staff, the number of appointments sent out for a session is l6. This number is considered to be too high, but it was anticipated that attendances would not be 100%. In fact, statistical analysis of attendances in all 12 centres are studied carefully every six months and the average attendances for the four age groups during the last completed four surveys were as follows Percentage attendances at Child Health Sessions in the prescribed age groups Period Age 1/12 Age 9/12 Age 2½ Age 4+ Total all groups 7.10.68 to 12.4.69 59 45 38 57 50 14.4.69 to 20. 9.69 63 51 41 56 53 22. 9.69 to 30. 5.70 63 51 42 59 54 1. 6.70 to 30.10.70 66 51 43 62 55 25 Doctors and health visitors work together as a team during the Child Health Sessions. Appointments are arranged so that children are assessed in the presence of their area health visitor who in turn informs the medical officer about the child's home background. The health visitor subsequently follows up by home visit to children who have failed their appointment and about whom they have no up-to-date knowledge. The health visitors have their own child welfare sessions to see mothers and children in their own area, and are available for consultation usually on a weekly basis, in the Child Health Centre or in general practitioner surgery where an attachment scheme is in operation. Children whose development is not normal and requires more detailed investigation are referred to one of our two Development Clinics on the east and west sides of the Borough. There are at present six Development Clinic sessions per month conducted in Newham. Three appointments are made for each session consisting of one new and two return cases. The team in the Development Clinic consists of a Consultant Paediatrician, a Senior Medical Officer specially trained in developmental paediatrics, a Social Worker (usually a P.S.W.) and a Health Visitor. In addition, the child's own Area Health Visitor is usually present to introduce the mother and child, and to give the team the background history of the child. The Development Clinic Team is supported by other specialists in the Local Authority Service, e.g. Audiology, Ophthalmology, Orthopaedics, Psychiatric etc., Speech Therapists, Teachers and other professional workers are invited when appropriate, to attend the Development Clinic for discussion of special cases. Liaison with hospitals and general practitioners is maintained. The Senior Medical Officer of the Local Authority is responsible for maintaining this liaison. This is strengthened where health visitors are attached to general practitioners and acting as hospital liaison health visitors. The Development Clinic Team assesses the child and continues the follow-up direct, or refers the child to an appropriate centre for further assessment, treatment or training. The Borough is well provided with day care facilities for handicapped children of all types in the form of nursery classes, in appropriate special schools, e.g. for physically handicapped, the deaf, the mentally handicapped etc. Where appropriate, an ordinary nursery school or day nursery, or play centre is recommended. The Speech Therapy Clinics admit also young children for assessment of specific problems related to speech. The periodic assessment and follow-up of children in the pre-school period is carried over into the schools by the School Health Service. The examination of children aged 4+ in the Child Health Clinics counts really as the pre-school assessment and is geared to the child's need in relation to pending school entry. The appointments are sent at 4 years and 3 months, to allow for treatment of any sensory or other defects before entering school. 26 We conduct only two periodic medical examinations of all school children during their school life; one in the second or third term after entry into the primary school, and the other after entry into secondary school, All other medical examinations in school are on a selective basis. The basis of selection is a conference in school (every term, staffing permitting), consisting of Head Teacher, School Medical Officer and School Nurse. Every member of the team can raise their problems and bring forward cases for discussion. Here children are selected for examination in addition to those who were considered in need of follow-up examination by the Medical Officer at the previous medical examination. Besides, each School Medical Officer has a weekly school clinic at which children are seen, referred by various agencies for special examination or referred by School Medical Officers themselves, when a problem may require more time than can be given during an examination at school. In view of the thorough follow-up of children in the pre-school period, the possibility of dispensing with periodic medical examinations in school and replacing them by selective examinations only was contemplated. It is however considered that the emotional impact of entry into school and the child's reaction and response in a learning situation, brings to light unexpected symptoms which fully justify an assessment of all children at this stage. Similarly, the entry into secondary school, the new environment, the impact of puberty and adolescence, again justify a "new look" at all school children at this critical stage of development, There is no routine examination at school leaving age. The follow-up of senior pupils on our selective basis, focuses attention on those leavers whose special problems have to be considered on leaving school and warrant communication with general practitioners and careers officers. Children with learning problems in school are brought to the attention of Educational Psychologists by the Head Teacher. The Psychologist's reports are forwarded to the Principal School Medical Officer. School medical records are then perused and any additional information including a health visitor's report on social background obtained ready for one of our standing Educational Case Conferences. The Conferences are attended by Educational Psychologists, Head Teachers of E.S.N. Schools, the Principal Medical Officer and the Senior Medical Officer for mentally handicapped children. In addition to the above regular members of the team, other professional workers such as Head Teachers, Social Workers, Speech Therapists and others who may have special knowledge of this particular child, are invited to make their contribution'. These conferences serve as a reference point for most matters relating to the mentally subnormal and severely sub-normal children, and all decisions relating to their education are made by the team. Severely emotionally disturbed children deemed maladjusted are dealt with by the Child Guidance Service. Handicapped children in special schools are under regular supervision of School Medical Officers who collaborate with other professional workers as may be appropriate for the type of handicap. This working of an interdisciplinary team is well exemplified in the case of our Elizabeth Fry Special School for Physically Handicapped Children. This School has a Nursery Class that was originally designated as a Cerebral Palsy Unit but admits now all young children with physical or multiple handicap. This School has a very well equipped medical unit with 27 facilities for physio, hydro and speech therapy, and a special class equipped and designed to teach children whose handicaps include deafness. These children and their progress are reviewed three times a term by a team of consultants, including Paediatrician, Consultant in Physical Medicine, Orthopaedic Specialist, Speech Therapist, Physiotherapist, Educational Psychologist, Head Teacher, Senior Medical Officer for Physically Handicapped Children and the School Nurse. The Consultant Audiologist and Ophthalmologist visit the school regularly on separate occasions and so parents and these severely disabled children are spared frequent journeys to a clinic or hospital outpatient department. Social Workers are either regularly attached or available for consultation and parents counselling. They regularly attend the Leavers'Conferences in Special Schools where they join the Head Teacher, Educational Psychologist, School Medical Officer and Careers Officer. Dyslexia Unit A Dyslexia Unit was originally established in the former Borough of West Ham in 1964. This is a special class in the charge of an interested and experienced, well-motivated teacher. The maximum number of children admitted to this class is six. This Unit offers the opportunity of intensive individual tuition for children of average intelligence who display specific difficulty in writing and reading. The controversial subject of dyslexia though not theoretically resolved is being dealt with pragmatically with very good results. The admission of children selected for the Unit is subject to agreement by the Senior Educational Psychologist and Principal Medical Officer. All the children attending this special class, at present situated in the Elizabeth Fry School, attend in the morning their own respective schools and are collected after lunch by car and brought to the Unit. They stay there all the afternoon and are taken back by car to their own school from where they make their way home. It is regretted that these provision!] are on a limited scale. The turnover is very slow and the average attendance at this Unit is 2-2i years. Speech Therapy Early in 1965, the Speech Therapy Service was reviewed in the light of the needs of the new Borough. As a result an additional Clinic has been set up to meet the needs of pre-school and school children. The staff establishment has been increased to six full-time Therapists and working conditions in three special schools greatly improved by the provisions of specially designed treatment rooms in each school. During this period there has been a growing link between speech therapy and allied services. In particular that with the Development Clinic has resulted in earlier observations and assessment of young children with delayed speech and language. Also, as the outcome of earlier screening for speech difficulties in the Child Health Clinics, more than half the children referred for speech therapy are now under 5-years. While a close watch is kept on subsequent development, and advice given to the parents, many of these children also attend weekly group therapy sessions for language stimulation. There has been a growing awareness of the need for intensive speech therapy allied to their educational needs for school age children with severe impairment of speech and language. To meet this need, a special Unit was established in June 1969. within a normal primary school. Here, 12 children attend daily and are integrated into the schools group system, but their special needs are catered for by a programme of remedial help by Teachers and Speech Therapists backed by a team which includes the Principal Medical Officer, an Educational Psychologist, and a Social Worker. 28 A continuing venture has been an annual summer camp, This has been most valuable in providing a relaxed setting for the valuation of speech defects and their associated problems, and also in giving an opportunity for a short spell of intensive therapy when advisable. Physiotherapy Regular physiotherapy sessions are carried out at the Elizabeth Fry Day School for the Physically Handicapped and the John F, Kennedy Junior Training Centre. Additional sessions are held subject to available staff and minor ailment clinics in the Borough and the Adult Training Centre. Physiotherapy staff also arrange pony riding exercises and swimming exercises for the disabled children. I hope I was able in this very brief summary to highlight some of the salient points in our Child Health Service. A discipline of developmental paediatrics cannot be practised in isolation. It requires the collaboration of professional workers in interdisciplinary scenes at all levels and stages of assessment. Starting with the Medical Officer, Health Visitor team in the Child Health Session, proceeding to more complex teamwork in the Development Clinic, Audiology Clinic, Education Case Conference, Leavers' Conferences, Special School Conferences, Dyslexia Unit Team, and Remedial Speech Therapy Teams. Hospital Consultants participate in the work in Clinics, special schools and centres. Liaison is maintained with General Practitioners and other Hospital Consultants which is sometimes reinforced by Health Visitor attachment schemes both to general practices and Hospitals. The experience in our Borough leads us to believe that community paediatric work is best carried out within the community with Hospital Consultants working in our Centres and special schools with other professional workers in the community, It is hard to believe that this complex work with interdisciplinary teams working in the community can be more effectively managed and organised from a Hospital Outpatient Clinic with one Local Authority Medical Officer in attendance acting as a Liaison Officer, Above all,the Consultants themselves by the interest and enthusiasm with which they participate in and enrich our work prove the validity of our policy. The complexity of administrative arrangements to make this scheme work is obvious and practical problems at first seemed to be insuperable, but I am glad to say it has been overcome and work in this Service is most rewarding. Dental Service The Chief Dental Officer, Mr. P. Chandler, reports as follows Over the period 1965/1970 there was a steady increase in the number of children having dental inspections in school each year. The increase was from about 50% of the school population in 1965, to approximately 10% in 1970. The number of fillings increased by about 20%, while the ratio of teeth filled to teeth extracted showed a continuous rise for both deciduous and permanent teeth. Work such as orthodontics, crowns, root fillings, etc. continued at a satisfactory level. The amount of treatment given to expectant and nursing mothers declined slightly, Since the abolition of a charge for dental treatment under the National Health Service for this section of the conmunity a falling off in demand for treatment from the local authority service has been a continuing trend, although this trend appears to be slowing up. The number of pre-school children treated increased and the ratio of teeth filled to teeth extracted showed a satisfactory rise. 29 In 1969 a dental officer was made responsible for the re-organisation of the dental service for handicapped children and for their treatment. The children are now collected at their schools or centres and taken in groups of six or seven to the dental clinics by special transport. After they have all received treatment they are driven back to their school or centre. Since re-organisation all handicapped children in the borough are inspected and offered treatment at least once a year. The acceptance rate for this group of children has gone up appreciably since the inception of the new schemes. Statistics are given in Tables F and G on pages 49 and 50. Dental Health Education Dental Health propaganda has been pursued by means of posters exhibited at clinics and schools, by the distribution of leaflets in schools and in clinics, by talks and film shows to classes in schools and by chairside instruction. Since 1968 two additional projects have been introduced, the first of these was the distribution of dental hygiene kits to infant school entrants during their first week at school. The kits consist of a toothbrush, plastic mug and tube of toothpaste. Enclosed with the kit is a letter to the parents on the subject of dental care. The second was the formation of a Clean Teeth Club. Children who have carried out oral hygiene instructions to the satisfaction of the dental officer for at least three months, are rewarded with a badge of membership. 30 PART V MENTAL HEALTH SERVICES 31 32 MENTAL HEALTH SERVICES The Principal Mental Health Social Worker, Miss E.M. Thomson, reports as follows:- "The multi-disciplinary team of Mental Health Social Workers, Psychiatrists, Psychologists, Child Psychotherapists with supporting administrative and clerical staff which makes this section of the Mental Health Department, moved its headquarters from 99 The Grove, E.15. to 70 West Ham Lane, in December 1966. The building, which had previously housed the Borough Architect's Department, was partially converted for our use and further alteration to allow for expansion of staff and functions was completed in 1968. The central core of the work still lies within the Statutory Services that must be provided, and this includes the emergency admission of patients to mental hospitals, the social after-care following discharge and the child guidance service. The last mentioned has been integrated with Community Care Services by the joint use of staff and organisation of records. Clinic sessions continue to be held at the Child Health Centre, West Ham Lane, E.15., and at Katherine Road Clinic, East Ham. Cases referred represent a wide range of problems calling for an equally wide range of therapeutic approaches. This involves the professional staff actively seeking consultation with other" agencies concerned, as well as direct work with families. The Work During the period under review, the increased number of patients discharged from hospital for community care alongside the development of drug therapy which enables other patients to remain at home, has created a considerable rise in case loads. The Council increased the establishment of mental health social workers from 18 to 20, and in addition converted one post to a more senior grade, Assistant Principal Mental Health Social Worker. The services of the Clinical Psychologist were also obtained and this has made a major contribution to the development of rehabilitative programmes and policy for people attending the Adult Training Centres. Work has expanded and contact widened, and whilst every effort is made to maintain those commitments entered into, the staff work under very great pressure. The use of the group of professionally qualified case workers who comprise the majority of Psychiatric Social Workers for statutory work, is an unusual feature of Newham and has done much to place the emergency admission to hospital in its proper context as one episode in a planned intervention to help family needs sometimes both before and after hospitalisation and in conjunction with family doctors and hospital psychiatrists. Relationships with hospitals The Mental Health Social Workers now have a good direct relationship with the hospitals. Goodmayes Hospital has expanded its out-patient facilities, serving the borough through daily clinics at either St. Mary's Hospital, Plaistow, or Queen Mary's Hospital, Stratford. Appointment of a Consultant Psychogeriatrician has increased the possibility of domiciliary visits and facilitated short-term admissions for rehabilitation and treatment of the elderly. The unsatisfactory circumstances of having to admit East Ham patients to Runwell Hospital, Wickford, situated some 30 miles to the east of the borough has continued, but it is hoped that the Regional Hospital Board will have completed its long awaited plan to recast catchment areas, so that Goodmayes Hospital caters for all Newham admissions, in the ensuing year of 1971• Despite this problem, efforts are made to maintain good links with Runwell Hospital and the out-patient clinic at East Ham Memorial Hospital serves as a focal point for local authority and hospital co-ordination. 53 South Ockendon Hospital for the mentally handicapped, due to government policy, has until recently been obliged to suspend all admissions both of children and adults. This has thrown a heavy burden on the resourcefulness of staff of the Mental Health Department in making alternative arrangements and we are grateful to other hospitals who have helped us during this emergency period. Nevertheless, shortage of beds remains a serious lack for the mentally handicapped and their families who are often subjected to intolerable strains at home. Additional areas of work These include:- (1) A Young People's Consultation Service which was established 3 years ago to care for those whose needs were not met by adult psychiatric services and who were not suitable for attending the Child Guidance service. Young people are encouraged to approach this service directly or are referred by their family doctor or educational establishment. More than one married couple has been referred to the service and the majority of cases has been concerned with problems of interpersonal relationships. (2) Handicapped Children - Mental Health Social Workers are attached to the Development Clinics, to the two Junior Training Centres, to the two schools for the educationally sub-normal children, and to the Elizabeth Fry School for the physically handicapped, and case loads are built up for long-term counselling of families and Mental Health Social Workers share with Health Visitors, Medical Officers and Teachers in the care and planning for the children. Representatives of all the disciplines employed in the Mental Health Service are also directly concerned either by consultation or by offering treatment. (3) Mentally Handicapped Adults - These people are not a statutory responsibility of the Health Department under present day legislation if they and their families can manage their own affairs efficiently, but at a time when there is stress because of changes in circumstances or demands made upon them, supervision and casework help may be offered in conjunction with Adult Training Centre staff and the same special attachment of Social Workers and opportunities for discussion and consultation exist as in the area of handicapped children. (4) Therapeutic Social Clubs - The department runs two of these which are held weekly at the Community Care Centre. Independent activities are encouraged as well as the provision of opportunities for social contact. The Phoenix Club has for several years, with the help of the Social Workers concerned, organised its own summer holiday and this has proved both popular and successful. (5) Liaison with Children's Department and Probation Department - This is a function mainly concerned with the Child Guidance Clinics. In addition Mental Health representatives attend the co-ordinating committee of the local authority and have participated in schemes such as those designed to help families with multiple problems, or the problem of battered babies. (6) Special links with several group practices of family doctors have been established by individual Social Workers. These have proved helpful in enabling referrals to be made at an early stage and for promoting the fullest co-operation and use of the whole range of Mental Health Services. 34 Centres There have been very considerable developments affecting all the Day Centres during the period under review. Increases in establishments which have the effect of increasing the staff/ trainee ratio has made diversification of activities a practical reality and in addition a policy of interchange between Centres is being pursued. In particular there has been an increase in the amount of teaching provided, in training in use of public transport and therefore towards increased independence and in physical activities such as swimming. Three mentally handicapped people attained a place in open employment during the year of 1969. One of the most urgent priorities as in other areas, has been the provision of more special care places, and this is likely to become accentuated in the course of time as expectation of life increases in this group. (1) Liverpool Road Advanced Training Centre In 1968 a new unit was opened consisting of an industrial workshop. A mixed group totalling 72 people, some mentally ill, some with physical handicaps, and some mentally handicapped can now be offered a full range of rehabilitative experiences. (2) Cumberland Road Senior Training Centre In 1970 this Centre for 70 adult mentally handicapped people was refitted and at the same time a special care unit for 15 people was added. A flat for domestic training and a classroom have made a wider range of training possible. (3) Melbourne Road, E.6. Senior Training Centre This Centre was opened on 27th January, 1970. With an eventual capacity for 150 people it already caters for some 80 adult mentally handicapped people and the staff are working out new techniques of training using the most up-to-date aids. (4) John F. Kennedy Centre. Junior Training Centre Opened in 1964 with a capacity for 120 mentally handicapped children, an additional 2 classrooms were provided in 1969 for 30 children. Of these places there are 13 full time and 19 part time set aside for doubly handicapped children, and these are allocated to the 32 children on a basis so as to provide care for as large a number as possible. There are in addition 8 children on the waiting list for this Centre. (5) School Road, E.12. Junior Training Centre Originally designed as a combined centre, after the adults transferred to the Melbourne Road Centre, E.6., in January 1970, this centre became entirely available for children and now houses 60. Individual holidays for short-term periods were arranged for some 59 children and adults during the year 1970. In addition the centre's staff have continued to organise group holidays for their trainees and because of their interest in making them a feature of centre activities, they have continued to be successful and to run smoothly. Special mention should be made of the arrangement for a bed retainer scheme at the Pirate Springs Convalescent Home, enabling us to utilise the equivalent of 2 beds per week throughout the year. Because of the variety of the arrangements that can now be made parents have been enabled to plan their own holidays knowing that with sufficient notice a synchronised holiday can be arranged for their handicapped child, and this has been much appreciated. 35 Residential facilities Placement continues of patients unable to live at home, in a variety of hostels and centres organised by other authorities and voluntary bodies, and these are inspected and carefully matched to individual needs by the Social Workers concerned. There is one area where Newham has been slow to make progress. This is in the provision of its own hostel accommodation, which is a statutory one. However, during 1970, building started on the Grange Road, E.13., hostel for the mentally ill which will house some 38 patients, with a possibility that some may progress to a separate annexe built to contain bed-sitting rooms for those capable of a more independent existence and some eventually to ordinary housing in the area provided through the co-operation of the Housing Department. Voluntary organisations Contact is maintained with many of the voluntary organisations serving the borough. Special mention must be made of excellent links with the Social Workers Luncheon Groups where various Church organisations offer a regular meeting place for voluntary and statutory workers, and many projects have been undertaken Jointly. Compilation of the Newham directory for Social Workers which is intended to help link together all those who are working for the social wellbeing of the families of Newham is one of these. Training The department discharges its responsibility for assisting the national trend towards training and raising standards of all personal social service personnel by employing trainees under supervision, some of whom later take up a secondment on full salary to a professional training course. Supervised placements of students from a wide variety of courses are also offered. In addition the staff are given opportunities to attend relevant courses outside the borough. Within the service special attention is paid to ensuring that the staff receive the help they need for their own professional development. These measures assist us in retaining the services of our high calibre staff, but there is nevertheless, a fairly rapid turnover, both for personal reasons and of people who can readily obtain more senior posts elsewhere. Statistics are given in Table 0 on page 55. 36 PART VI ENVIRONMENTAL HEALTH SERVICES 37 38 ENVIRONMENTAL HEALTH SERVICE The Chief Public Health Inspector, Mr. E.R.H. Hodge, reports as follows. General Public Health During the years under review, general inspections have shown only slight variation in numbers per annum. For example, the number of complaints received averaged approximately 5,500. Drainage tests 2,500, Infectious Diseases 250, Pood and Drugs Act approximately 3,000 and reinspections approximately 8,500. The number of notices served decreased as did the number of summonses served and cases heard, the latter fell from 119 in 1965 to 51 in 1970. Work under the Rent Acts was slightly less in 1970 than in 1965, possibly due to the continual decrease in the number of properties coming within rent control, either by demolition under redevelopment schemes, by improvement and the granting of Qualification Certificates and by the change of tenancy. Food and Drugs Act and Regulations The Section has endeavoured not only to keep up the standard of food hygiene in premises generally but to improve it, the number of visits per annum averaging 3,000, indicates the attention paid to this facet of the work. Fortunately, seldom has official action been necessary, and few cases have had to be referred for action in the Courts. As to quality control, the average number of samples taken for chemical analysis was about 500 and bacteriological samples were about 250 per annum. Our policy is to sample as a first priority, those articles of food produced in this Borough. The second priority is of food imported into the country via the London International Freight Terminal, and lastly those items marketed nationally and, therefore, subject to sampling and analysis by many other local authorities. One of the more important items in this part of the work of the Section is the manning of the London International Freight Terminal. The conditions at the Terminal are such that it is designated as a Port and has full Customs and Excise staffing control, and, therefore, the London Borough of Newham has become a Port and the Public Health Inspectors Section is responsible for all food imported through the Terminal. The Terminal is manned full time by one Public Health Inspector working on a rota system at a time of one month. The Inspector is responsible for inspecting all consignments of food, checking for correctness of labelling, constituents and conditions in compliance with the relevant legislation, and that it has come from approved establishments and the markings on each consignment coincide with the import manifest. At one time it was necessary for the inspection of fresh meat to be carried out Sunday nights between midnight and 6.00 a.m. on Monday. This practice has ceased, at least for the time being. Samples for both bacteriological and chemical examination are taken and consignments can be detained if there is any discrepancy in any way and if no satisfactory explanation is forthcoming within a specified time, they can be detained or re-exported to the country of origin. Meat Inspection The inspection of meat at the two abattoirs within the Borough is carried out by an authorised Meat Inspector, together with one Public Health Inspector working on a rota system. The number of animals slaughtered has dropped from the peak of 72,000 per annum in 1966 to about 43,000 in 1970. 39 Water Supply All water throughout the London Borough of Newham is supplied by the Metropolitan Water Board and is satisfactory in quality and quantity. All premises are supplied directly from the mains. The proposal to introduce fluoridation of water supplies in the Metropolitan Water Board's area has been supported by the Newham Council, but has not,yet received the unanimous support of other Authorities in the Water Board's area of supply. Sewerage and Sewage Disposal Arrangements for the disposal of sewage are adequate for the area, disposal being through the Greater London Council's Northern Outfall Sewer. Swimming Baths There are four public, four schools and two private swimming baths in the Borough and samples are taken regularly for analysis. Clean Air Act A programme of introducing smoke control orders throughout the Borough has continued, and the Newham Smoke Control Orders Nos. 3,4,5,6 and 7 have been made, and Nos. 8 and 9 should follow in 1970/71. Altogether some 35,000 properties are now included in smoke control orders. The problems arising from dust and fume emission from industrial premises as well as from noise involve members of the staff in long and sometimes cold vigils, in order to make observations and recordings. A considerable proportion of the observations are made between 9.00 p.m. and 3.00 a.m. including weekends. A great deal of time and work has been spent on these aspects of environmental pollution. New measuring equipment has been purchased and the officers trained in its use by attendance at special courses. It is now an almost standard procedure for industrial undertakings when thinking of altering or building new plants to consult not only the Chief Building Surveyor and the Planning Officer, but also the Public Health Inspectors Section. In turn the Inspector will, if he thinks it necessary, consult with either or both Her Majesty's Factory Inspectorate and the Alkali Inspector, so that when the Department makes a recommendation to the appropriate Committee all aspects will have been fully investigated. Offices, Shops and Railway Premises One Inspector who was carrying similar duties with the former County Borough of East Ham now carries out the same duties under the above Act •and its many Regulations. He and the District Public Health Inspectors have very close co-operation which enables action to be taken without delay. The main object of the legislation is to protect the workers not already covered by the Factories Act, and it covers ventilation, furniture, lighting, safety precautions for all types of office and shop machinery. Although much of this is a repetition of previous legislation brought up-to-date and improved, it also includes safety of flooring and staircases. Considering the number of shops and offices concerned, the number of offences is small. 40 Offensive Trades and Fertilisers and Feeding Stuffs Act These apparently widely differing subjects are grouped together because they are interrelated. The Offensive Trades are concerned with the offals, condemned meat and butchers waste. They provide an important service to the community by processing this waste which would otherwise be deposited at the refuse tips where it would attract rodents. From the waste are produced tallow, gelatine, bone meal and greaves. Greaves forms the basis for many animal feeding stuffs. The degreased bones and fibre are ground separately and mixed with other ingredients and sold as poultry, pig, calf and other such feeds. Over 126 different varieties are produced in this Borough. Regular samplings of these products has been carried out and has often resulted in improvements in processing and avoidance of nuisance to the public. Pest Control Investigations are carried out by the Pest Control Officer and his Assistant to confirm the type of infestation and to decide the type of bait to be used. The regular and continuous baiting of public sewers has been carried out and has kept the rat population at a low level. Statistics show a steady rise in operational visits against rodents and this is mostly due to the Warfarin nesistance in mice. Operations against bed bugs and other insect pests have continued to be necessary despite the introduction of residual insecticides. This may be partly due to more properties being centrally heated, thus extending the normal breeding time of the pests and partly due to insecticitle resistance. These conditions lead to more operational visits being necessary and changes of insecticides have to be made in order to eliminate these pests. Many operations have been carried out against feral pigeons by narcotising in order to contain their numbers. This is carried out under licence from the Ministry of Agriculture, Fisheries and Food, and a representative of the Ministry is usually present at each operation. The public could help very considerably by not feeding these birds, as unlike the wood pigeon which normally has no more than two broods of two eggs each year, the feral pigeon if nesting conditions and food supplies are satisfactory, are known to have up to six broods in twelve months, and this alone gives one an indication of the size of the problem if no containment were attempted. The damage these birds cause to buildings, regardless of the disfigurement, is large and they are known to carry certain diseases capable of being transmitted to human beings. Housing Houses in multiple occupation require a disproportionate amount of attention from the Public Health Inspectorate. In this Borough over 5,000 houses are known to be in multiple occupation and a special Section has been set up to deal solely with these houses. Owing to the constant change of management of houses in multiple occupation, Notices have frequently to be served more than once causing considerable delay before repairs can be carried out and the properties brought up to standard. Management Orders are now being used effectively and a Registration Scheme has been prepared for Government approval. 41 Housing and Redevelopment Programme Action was taken in 1965 to ensure continuity of the clearance and redevelopment programme of the two former County Boroughs. A cycle of work was arranged so that inspections of properties were carried out, the clearance areas delineated, official representations and maps prepared and presented to the Council's Committees at appropriate time intervals, so that Compulsory Purchase Orders and the consequent administrative work including holding of Public Inquiries, carried out as quickly as possible. In this way the re-housing of occupants and the demolition of properties could all be accomplished in about three years. A Working Committee met monthly to plan phasing of work and also ensured that any problems arising were fully resolved. Nearly 20,000 visits have been made in the past six years in 191 Clearance Areas. Improvement Grants and Improvements Areas Although Improvement Grants were originally dealt with by the Public Health Inspectors Section, they are now dealt with by the Valuation Section of the Borough Engineer's Department and the Public Health Inspectors Section only advises on the probable life of the properties concerned and whether or not they are included, or likely to be included in future redevelopment schemes. General Improvements Areas under the 1969 Housing Act will become an increasingly important means of preserving and improving older properties, and in these cases the Public Health Inspector carries out the original inspection of the areas and the Working Party formed by members of all Departments then co-operate in assessing the possibilities and the costs. As an indication of the amount of work involved some 4 Areas have been examined totalling approximately 3,000 properties and before the first of the Areas is finally completed, many more visits and consultations will have to be made. Statistics relating to environmental health are given in Table R on page 58. 42 PART VII APPENDIX OF STATISTICAL TABLES 43 44 45 LONDON BOROUGH OF NEWHAM - HEALTH DEPARTMENT STATISTICAL SUMMARY FOR 1965 to 1970 TABLE A - BIRTHS 1. (a) Notified Births adjusted by Inward and Outward Transfers Live Births Stillbirths . 1965 1966 1967 1968 1969 1970 1965 1966 1967 1968 1969 1970 Domiciliary 719 718 635 581 494 404 2 5 - 6 2 4 Institutional 4393 1501 1364 4200 4015 3934 102 83 77 79 71 67 Total 5112 5219 4999 4781 4509 4338 104 88 77 85 73 71 TOTAL 1965 1966 1967 1968 1969 1970 Domiciliary 721 723 635 587 496 408 Institutional 4495 4584 4441 4279 4086 4001 Total 5216 5307 5076 4866 4582 4409 (b) Registrar General's Adjusted Figures: 1965 1966 1967 1968 1969 1970 Total Live Births 5162 5258 5H3 486l 4539 4384 Total Stillbirths 104 82 76 83 75 71 2. Birth rate per 1,000 population 20.2 20.6 19.9 19.1 18.0 17.7 3. Illegitimate Live Births: % of total live births 9.3 8.8 9.7 10.4 10.0 11.0 4. Stillbirths rate per 1,000 total live and stillbirths 20.0 15.0 15.0 17.0 16.0 16.O 46 B- INFANT AND MATERNAL MORTALITY (ADJUSTED) 1965 1966 1967 1968 1969 1970 1. Number of Infant Deaths (under 1 year) 103 99 97 114 86 90 2. Infant Mortality Rates (a) Total Infant death's per 1,000 total live births 20 18.8 19.0 23.4 19.0 20.5 (b) Legitimate infant deaths per 1,000 legitimate live births 19.9 18.0 18.8 23.2 18.0 20.0 (c) Illegitimate infant deaths per 1,000 illegitimate live births 20.9 28.1 20.2 26.0 27.0 255 3. Neo-Natal Mortality Rate (Deaths under four weeks per 1,000 total live births) 13.4 13.1 12.5 16.0 13.0 15.5 4. Early Neo-Natal Mortality Rate (deaths under one week per 1,000 total live births) 11.2 12.4 10.4 14.0 12.0 13.2 5. Perinatal Mortality Rate (stillbirths and deaths under one week combined per 1,000 total live and stillbirths) 30.8 27.5 24.9 30.5 28.0 29.0 6. Maternal Mortality (including abortion) (a) Number of Deaths 8 3 3 2 1 2 (b) Rate per 1,000 total live and stillbirths (As adjusted by the Vital Statistics published by the Registrar General) 1.5 0.6 0.6 0.4 0.2 0.45 c - PREMATURE BIRTHS 1. Total number of Premature Births - Live 316 312 324 348 319 295 2. Total Number of Premature Stillbirths 65 49 50 52 43 45 3. Number of Premature Live Births - deaths within (a) 24 hours of birth 24 21 31 31 22 21 (b) 24 hours - 7 days of birth 15 19 6 14 13 17 (c) 7 days - 28 days of birth 1 2 6 2 3 3 47 D - DEATHS Deaths of residents who died in the Borough (adjusted) Age Group Male Female 1965 1966 1967 1968 1969 1970 1965 1966 1967 1968 1969 1970 Under 1 month 43 44 33 43 35 33 26 25 31 36 24 35 Over 4 weeks and under 1 year 16 16 16 19 16 10 18 14 17 16 11 12 Over 1 and under 5 years 2 10 6 10 5 5 8 6 5 9 4 2 5 to 65 years 573 601 536 561 544 484 296 312 300 295 321 26l Over 65 years 912 901 831 865 962 874 985 958 933 1042 1011 1005 Total - All Age Groups 1546 1572 1422 1498 1562 1406 1333 1315 1286 1398 1371 1315 TOTAL 1965 1966 1967 1968 1969 1970 Under 1 month 69 69 64 79 59 68 Over 4 weeks and under 1 year 34 30 33 35 27 22 Over 1 and under 5 years 10 16 11 19 9 7 5 to 65 years 869 913 836 856 865 744 Over 65 years 1897 1859 1764 1907 1973 1880 Total - All Age Groups 2879 2887 2708 2896 2933 2721 E - NOTIFIABLE INFECTIOUS DISEASES ~ 1965 1966 1967 1968 1969 1970 Infective Jaundice Not notifiable untill 1968 30 62 111 Scarlet Fever 110 77 59 103 98 80 Whooping Cough 99 115 218 96 27 189 Measles 2380 1310 2277 375 1575 690 Poliomyelities (a) Paralytic - - - - - 1 (b) Non-Paralytic - - - - - - 48 E- NOTIFIABLE INFECTIOUS DISEASES (CONTD.) 1965 1966 1967 1968 1969 1970 Tuberculosis (a) Respiratory 108 13? 79 109 82 89 (b) Meninges & C.N.S. - 1 1 1 2 2 (c) Other 17 23 22 22 38 25 Diphtheria - - - - - - Dysentery 84 105 21 40 36 8 Puerperal Pyrexia 3 1 5 2 Not now notifiable Acute Pneumonia 28 22 23 18 Not now notifiable Food Poisoning 33 70 81 67 113 86 Meningococcal Infection 1 1 - - 5 7 Ophthalmia Neonatorum 1 - 1 2 1 - Paratyphoid Fever - - 1 - - 1 Typhoid Fever - 1 - 1 l 3 Acute encephalitis Infective - - 2 - - 1 Post Infectious - - - - 3 - Malaria - - - - - 2 Anthrax 1 - - - - - F - CLINIC SERVICES 1. Ante-Natal and Post-Natal Clinics:- (a) Number of Individual Mothers in Attendance 2089 2085 1815 1557 1294 1009 (b) Total Number of Attendances 9519 9458 8520 7459 6227 4382 (c) Total Number of Sessions held 611 611 618 452 492 428 2. Mothercraft and Relaxation Classes:- (a) Number of Women who attended 445 465 1+80 332 246 196 (b) Total Number of Attendances 2606 1742 1776 1253 1026 811 3. Child Health Clinics (under 5 years of age):- Total Number of Attendances 47572 48157 46000 39378 36023 36313 49 4. Dental Services for Expectant and Nursing Mothers and Children under 5 Years Children Mothers 1965 1966 1967 1968 1969 1970 1965 1966 1967 1968 1969 1970 First Inspections 1121 1351 1263 1432 1159 1633 341 332 285 177 180 230 Found to require treatment No record 1251 1190 1303 1002 1098 No record 310 219 165 176 213 Offered Treatment „ 1246 1190 1290 995 108l „ 310 219 165 174 213 First Visits for treatment 747 1231 1168 1279 982 1002 290 300 231 160 150 210 Total Attendance for treatment 26l4 2437 2593 2792 2294 2332 1533 969 757 472 522 686 Number supplied with dentures (full and part) - - - - - - 78 62 50 27 23 35 G - SCHOOL HEALTH SERVICE 1965 1966 1967 1968 1969 1970 1. Periodic Medical Inspection:- (i) Number of Pupils found not requiring examination No record 520 827 812 581 57l (ii) Number of Pupils who received a full examination 8171 7854 8354 8203 10273 11204 (iii) Number of Pupils found to require treatment 1688 1182 2296 1948 2462 3021 2. Other Medical Inspections:- (i) Number of Special Inspections 12674 4644 3937 2376 2232 3281 (ii) Number of Re-Inspections 2937 2890 1913 248 290 326 3. Infestation with Vermin:- (i) Total Number of individual examinations of pupils 61535 49635 63712 57638 65671 63254 (ii) Total Number of individual pupils found to be infested 326 418 380 509 527 561 (iii) Number of Statutory Notices or Orders served - - - 3 3 - 4. Number of Pupils who received treatment for (a) Eye Diseases, Defective Vision and Squint External & Other, excluding errors of refraction and squint 447 297 158 81 59 74 Errors of Refraction (including squint) 2296 4283 3335 2650 2682 2335 Total 2743 4580 3493 2731 2741 2409 Prescribed spectacles 1515 3366 1934 1777 1961 1617 50 4. Number of Pupils who received treatment for 1965 1966 1967 1968 1969 1970 (b) Diseases and Defects of Ear, Nose & Throat Diseases of the Ear - Operative Treatment 71 29 21 27 61 102 Adenoids and Chronic Tonsillitis Operative Treatment 393 321 231 149 112 130 Other Nose & Throat Conditions Operative Treatment 11 33 50 30 28 20 Other Forms of Treatment 745 453 452 400 349 292 Total 1220 836 754 606 550 544 Pupils Attending School who were Prescribed Hearing Aids 18 10 18 15 15 22 Pupils Prescribed Hearing Aids in Previous Years 85 98 103 145 112 91 (c) Orthopaedic and Postural Defects - Pupils treated at Clinics or Outpatient Departments 203 141 200 257 227 192 (d) Diseases of the Skin treated - (i) Ringworm - Scalp 3 - 2 13 9 1 Body 29 - 1 7 6 - (ii) Scabies 3 10 - 1 6 4 (iii) Impetigo 9 4 7 12 8 18 (iv) Other Skin Diseases (including Warts) 1348 471 752 897 1003 949 (e) Speech Therapy - Pupils treated by Speech Therapists 320 350 351 387 462 513 (f) Other Treatment Given - (i) Pupils with Minor Ailments 654 272 117 105 98 74 (ii) Pupils who received Convalescent Treatment 82 72 69 68 80 57 (iii) Other Conditions 839 429 806 426 852 990 51 5. Dental Inspection and Treatment Number of pupils 1965 1966 1967 1968 1969 1970 (i) Inspections (a) First Inspection at Schools 19335 25094 23572 24883 30646 28486 (b) First Inspection at Clinics 6974 6944 8069 7794 5300 5280 (c) Number of (a) + (b) found to Require Treatment 19688 23895 22962 22769 23968 22499 (d) Number of (a) + (b) Offered Treatment 17618 21959 20894 20497 20830 18373 (e) Re-Inspected at School or Clinic 2093 2473 2650 2544 5720 5956 (f) Number of (e) Found to Require Treatment 1650 2139 2245 2324 4537 4658 (ii) Treatment Number of Individual Pupils Treated 11020 11243 11811 10187 10531 9227 Total Number of Attendances 28430 30181 31063 29031 30062 27640 (iii) Number of Pupils who Received Orthodontic Treatment 436 411 404 372 302 320 (iv) Number of Pupils Supplied with Dentures (Full or Part) 59 59 67 42 29 29 H - SCREENING TESTS 1. Phenylketonuria Testing of Urine - Children under 5 years (a) Number Tested 4416 4322 4809 4023 3836 631 (b) Number Positive - 3 - - - - 2. Vision Testing - Children of School Age (i) Aged 5 years (a) First Test 2924 3182 2849 3615 1962 910 (b) Re-Test 308 402 291 498 140 129 (c) Number of (a) and (b) Referred to Medical Officer 186 188 155 243 111 31 (ii) Aged 8 years and above (a) Tested 15238 16177 15418 16126 9428 12171 (b) Referred to Eye Clinic 644 724 648 600 710 622 52 3. Screening Tests for Hearing (By Health Visitors) 1965 1966 1967 1968 1969 1970 First Test 2582 2026 3148 2859 2096 1837 Re-Test 185 l84 225 196 198 112 Referred to Audiology Unit 51 39 62 52 43 31 Audiometric Tests Number of Children given test 5652 5601 5516 4600 6268 6428 Number failing test and given pure tone test 1451 1572 1480 812 1598 2224 Number failing pure tone test and referred to Otologist 578 678 517 510 586 649 I - HEALTH VISITING Cases Visited By Health Visitors Children under 1 Year of Age 4939 5274 4793 4647 4336 4099 Children 1-5 Years of Age 11316 10405 10992 10869 9636 9663 School Children (Number of Follow-up Visits) - - - 319 377 - Persons Aged 65 Years or Over 1164 843 856 891 693 793 Mentally Disordered Persons 124 121 180 127 178 162 Persons, Excluding Maternity Cases Discharged from Hospital 557 856 163 153 141 140 Number of Tuberculous Households Visited 67 45 49 34 72 61 Other Infectious Diseases - Household Visited 114 9 21 28 30 28 Other Cases 5403 5367 7029 7834 7781 10101 Total Number of Cases 23684 22920 24083 24583 23244 25047 Number of Tuberculous Households Visited by Tuberculosis Health Vistors 1590 1629 1929 1188 1052 817 J - MIDWIFERY 1. Domiciliary Confinements Attended (a) Doctor Not Booked and (i) Present at Delivery) 68 53 - 6 4 - (ii) Not Present) 38 22 3 7 (b) Doctor Booked and (i) Present at Delivery) 612 645 83 77 46 56 (ii) Not Present) 459 442 374 307 Total 680 698 580 547 427 370 2. Cases Attended - Hospital Discharges Before the Tenth Day 289 321 549 591 444 681 53 K - HOME NURSING 1. Number of Persons Nursed During the Year- 1965 1966 1967 1968 1969 1970 (i) Under the Age of 5 Years at First Visit 45 82 91 44 46 32 (ii) Aged 65 Years and Over at First Visit 1697 1666 1789 1582 1640 1685 (iii) Total Number (All Groups) 2943 2750 2842 2678 2540 2467 2. Total Number of Visits Made 110245 111265 110475 111365 108600 109535 L- HOME HELP SERVICE 1. Number of Cases Helped During the Year- (i) Aged 65 Years and Over 2804 2838 3089 3258 3189 3466 (ii) Aged Under 65 Years (a) Chronic Sick and Tuberculous 306 298 207 285 273 202 (b) Mentally Disordered 19 21 22 26 11 18 (c) Maternity 40 37 27 26 12 12 (d) Others 58 48 62 70 97 138 2. Total Cases (All Groups) 3227 3242 3407 3665 3582 3836 M- DAY NURSERIES AND DAILY MINDERS 1. Day Nurseries Maintained by the Authority- (a) Number of Premises 2 2 2 2 2 2 (b) Number of Approved Places 105 105 105 105 105 105 (c) Average Daily Attendance 95 83 91 96 91 88 (d) Number of Children on Register at End of Year 126 118 120 122 117 109 2. Daily Minders and Premises Registered Under the Nursery and Child Minders Regulation Act, 1.948. (i) Number of Premises 1 1 2 2 3 29 (ii) Number of Places Provided (i) at Year End 25 25 80 80 120 944 (iii) Number of Daily Minders 60 13 15 27 97 152 (iv) Number of Places Provided by (iii)at Year End - 79 82 125 248 327 3. Number of Play Groups Provided:- (a) By the Council - - - 2 2 4 (b) Privately - - 22 25 27 54 N - UNMARRIED MOTHERS 1965 1966 1967 1968 1969 1970 1. Number of Persons Assisted - - 122 141 117 122 2. Number of Persons Placed in Mother and Baby Homes - - 29 40 33 30 3. Number of (2) above Financially Assisted - - 29 40 33 30 4. Number of Cases Requiring Assistance After Birth of Baby - - 40 68 55 50 5. Number of Mother and Baby Homes in the Area:- (a) Local Authority - - - - - - (b) Voluntary Organisations 1 1 1 - - - 0 - MENTAL HEALTH 1. Number of Persons Under Care at the End of the Year - (a) Mentally Handicapped & Severely Mentally Handicapped Male 236 251 270 328 380 395 Female 195 208 220 261 296 314 (b) Mentally 111 Male 236 323 521 716 981 1133 Female 327 578 1018 1404 1845 2127 2. Receiving Home Visits at the End of the Year - (a) Mentally Handicapped & Severely Mentally Handicapped Male 103 117 116 153 203 204 Female 86 102 84 89 151 156 (b) Mentally 111 Male 218 308 499 694 955 1112 Female 303 563 1001 1388 1825 2112 3. In Attendance at Training Centres at the End of the Year (a) Mentally Handicapped & Severely Mentally Handicapped Male 118 123 142 164 169 185 Female 102 101 124 140 141 154 (b) Mentally 111 Male 16 13 14 16 17 15 Female 22 13 12 14 15 13 55 0 - MENTAL HEALTH (CONTD.) 4. Awaiting Admission to Training Centre at Year End 1965 1966 1967 1968 1969 1970 (a) Mentally Handicapped & Severely Mentally Handicapped Male 8 7 16 3 2 - Female 6 3 8 - 4 - (b) Mentally 111 Male - - 8 2 6 2 Female - - 3 - 4 - 5. Awaiting Admission to Hospital at Year End (a) Mentally Handicapped & Severely Mentally Handicapped Male 12 23 28 1 30 16 Female 6 5 1 11 11 (b) Mentally 111 Male - - - - - - Female - - - - - - 6. Number of Admissions to Temporary Residential Care (a) Mentally Handicapped & Severely Mentally Handicapped Male 11 67 83 69 2 118 Female 6 37 64 43 6 106 (b) Mentally 111 Male - - 2 35 - 5 Female - 1 49 - 9 7. Referred to the Service During the Year By (a) General Practitions 158 139 173 125 110 127 (b) Hospitals 151 230 224 192 383 287 (c) Local Education Authorities 32 56 50 67 62 20 (d) Police and Courts 26 23 18 3 13 10 (e) Other Sources 109 151 224 258 250 181 56 0 - MENTAL HEALTH (CONTD.) 8. Training Centre Provision:- Places Age Group Provided For No. of Premises Junior Adult 1965 1966 1967 1968 1969 1970 1965 1966 1967 1968 1969 1970 Junior 1 120 120 120 151 151 210 - - - - - - Adult 2 25 25 24 15 15 - 115 115 108 168 175 290 Total 3 145 145 144 166 166 210 115 115 108 168 175 290 9. Number of Social Clubs Provided 2 1965 1966 1967 1968 1969 1970 10. Number of Persons Seen by Young People's Consultative Service - - - 30 28 32 P - VACCINATION Courses of Vaccination and Immunisation Completed for Persons under the Age of 16 Years Primary Courses Booster Doses 1965 1966 1967 1968 196$ 1970 1965 1966 1967 1968 1969 1970 1. Diphtheria 4830 5274 4988 4324 2584 3147 3400 3998 4850 4347 3559 2354 2. Whooping Cough 3876 4778 4431 4017 2428 3035 2094 2241 2475 2846 2136 980 3. Tetanus 5122 5651 5501 4534 2765 3265 3675 4566 5589 4833 3920 2541 4. Poliomyelitis 5435 5648 4988 4223 2557 3183 3963 4049 4687 4107 3780 3549 5. Smallpox 1701 2498 2757 2845 2205 1529 231 1064 372 188 151 244 6. Measles - - - 4094 1932 2028 - - - - - - 57 Q - B.C.G. VACCINATION Persons Vaccinated Against Tuberculosis 1. Contacts of Confirmed Cases of Tuberculosis 1965 1966 1967 1968 1969 1970 (a) Number Skin Tested 663 831 787 940 927 863 (b) Number Found Positive 276 278 251 303 334 322 (c) Number Found Negative 387 553 536 637 593 541 (d) Number Vaccinated 221 400 373 412 614 600 2. School Children and Students (a) Number Skin Tested 308 1791 1662 1932 2327 3168 (b) Number Found Positive 85 421 434 504 658 921 (c) Number Found Negative 223 1370 1228 1428 1669 2247 (d) Number Vaccinated 223 1370 1101 1425 1969 2624 R - PUBLIC HEALTH INSPECTION 1. Visits Made During the Year (a) On Complaints Received 5691 5741 6242 5679 5103 5212 (b) Drainage Inspection and Tests 2689 2540 3343 2l6l 2712 3325 (c) Notifiable Infectious Diseases 284 251 259 257 370 302 (d) Factories Act 485 530 561 328 118 147 (e) Food and Drugs Act, 1955 3269 3901 4498 1682 2997 3219 (f) Diseases of Animals Act 68 52 85 89 47 54 (g) Housing Purchase & Housing Act, 1959 1495 662 109 33 164 43 (h) Offensive Trades 185 245 296 191 135 112 (i) Rent Act, 1957 81 130 48 59 14 16 (J) Clean Air Act, 1956 1783 6310 6445 9138 5881 4864 (k) Slaughterhouses 960 1037 1053 681 355 502 (1) Offices, Shops and Railway Premises Act 4441 3633 2861 2125 2038 1864 (m) Re-Inspections 9585 10981 10452 8679 8981 8671 (n) Other Visits 4680 5730 5130 5309 4047 5437 2. Houses Inspected Under the Housing Acts (a) Clearance Areas 3568 5058 4706 3568 3054 2371 (b) Individual Unfit Houses 215 167 231 157 88 129 (c) Houses in Multiple Occupation 673 415 467 145 258 1548 (d) Overcrowding 95 70 71 46 2 46 58 3. Notices etc. Served- Served Complied With 1965 1966 1967 1968 1969 1970 1965 1966 1967 1968 1969 1970 (a) Intimations 2539 2385 1867 1903 1444 1252 1997 2263 2238 1789 1187 989 (b) Statutory 907 1057 881 880 1258 961 913 967 1013 676 626 773 (c) Total 3446 3442 2748 2783 2702 2213 2910 3230 3251 2465 1813 1762 (d) Summonses Issued 119 176 88 52 34 56 (e) Summonses Heard 100 148 75 47 34 51 4. Sampling- (a) Pood and Drugs- (i) Chemical Analysis 529 542 526 491 486 474 (ii) Bacteriological Analysis 274 286 528 282 285 516 (b) Fertilisers and Feeding Stuffs 34 52 40 25 12 29 (c) Domestic Water Supplies - - - - - 247 (d) Swimming Bath Water 61 50 63 49 41 96 (e) Rag Flock and Other Filling Materials 12 16 12 1 2 6 5- Meat Inspection Animals Slaughtered and Inspected During Year 1965 1966 1967 1968 1969 1970 Bulls 57 297 35 23 13 3 Bullocks 14155 14102 14845 15227 13552 13561 Cows 946 1276 849 784 40 39 Calves 5695 3889 3570 3877 3798 5438 Sheep 18961 23535 10286 1688 48l 6 Lambs 17248 28739 29680 28325 21989 24071 6. Pest Control Complaints investigated 1965 1966 1967 1968 1969 1970 1965 1966 1967 1968 1969 1970 Rodents 2261 2226 2804 2807 3935 3011 10624 9811 13413 16087 20642 15775 Pigeons 28 17 8 10 15 4 43 19 23 19 24 7 Disinfestation (Vermin) 904 949 1166 864 990 777 886 812 1058 935 1073 843 Disinfection 29 18 49 47 83 97 32 21 49 48 85 101 59 Total Deaths bv Cause and Age of Newham Residents Causes of Death Sex 1965 1966 1967 1968 1969 1970 Enteritis and Other Dlarrhoeal Diseases M N/A N/A N/A 0 2 1 F 0 2 2 Tuberculosis of Respiratory System M 8 10 12 5 3 9 F 2 1 7 4 2 1 Other Tuberculosis, Incl. Late Effects M 1 1 0 5 4 2 F 1 1 1 4 0 3 Meningococcal Infection M 0 0 1 0 1 0 F 1 0 0 0 0 0 Malignant Neoplasm, Buccal Cavity Etc. M ) 11 6 6 7 4 5 F ) 2 2 Malignant Neoplasm, Oesophagus M ) 14 9 11 17 5 5 F ) 6 5 Malignant Neoplasm, Stomach M 62 54 66 42 62 54 F 37 45 37 32 37 33 Malignant Neoplasm, Intestine M ) 96 89 80 78 25 32 F ) 40 31 Malignant Neoplasm, Larynx M ) F ) 7 4 4 2 5 1 4 1 Malignant Neoplasm, Lung, Bronchus M 168 193 169 155 193 148 F 29 28 43 39 44 32 Malignant Neoplasm, Breast ■ M 0 0 2 1 0 0 F 67 51 60 44 70 68 Maligant Neoplasm, Uterus M 0 0 0 0 0 0 F 19 23 16 13 21 13 Malignant Neoplasm, Prostate M 16 14 21 17 22 19 F 0 0 0 0 0 0 Leukaemia M 6 11 7 ' 11 4 10 F 9 9 6 7 4 7 Other Malignant Neoplasms M ) 152 143 162 177 85 78 F ) 82 81 Benign and Unspecified Neoplasms M N/A N/A N/A 2 4 7 P 4 4 3 Diabetes Mellitus M 10 10 5 13 11 10 F 23 20 16 21 21 20 Avitaminoses, Etc. M N/A N/A N/A 0 1 1 P 3 1 0 6o Causes of Death Sex 1965 1966 1967 1968 1969 1970 Other Endocrine Etc. Diseases M N/A N/A N/A 4 4 2 F 4 6 1 Anaemias M N/A N/A N/A 2 3 4 F 8 10 10 Other Diseases of Blood, Etc. M N/A N/A N/A 1 1 0 F 0 1 3 Mental Disorders M N/A N/A N/A 1 4 4 F 1 2 2 Other Diseases of Nervous System, Etc. M N/A N/A N/A 11 11 7 F 14 10 10 Chronic Rheumatic Heart Diseases M N/A N/A N/A 19 23 21 F 33 36 24 Hypertensive Disease M N/A N/A N/A 23 35 22 F 39 34 40 Ischaemic Heart Disease M N/A N/A N/A 349 359 352 F 255 248 245 Other Forms of Heart Disease M N/A N/A N/A 43 53 48 F 87 73 73 Cerebrovascular Disease M 130 134 103 108 110 97 F 158 212 185 209 192 156 Other Diseases of Circulatory System M N/A N/A N/A 49 36 42 F 61 80 70 Influenza M 3 2 2 6 11 3 F 1 3 5 11 6 3 ( Pneumonia M 112 94 72 110 93 115 F 106 106 87 122 130 131 Bronchitis and Emphysema M 147 174 132 136 191 145 F 59 47 63 57 50 58 Asthma M N/A N/A N/A 4 2 3 F 8 5 2 Other Diseases of Respiratory System M N/A N/A N/A 29 14 8 F 16 11 8 Peptic Ulcer M 12 15 15 25 12 18 F 8 12 8 11 9 11 Appendicitis M ) 5 0 3 2 2 0 F ) 2 1 0 61 Causes of Death Sex 1965 1966 1967 1968 1969 1970 Intestinal Obstruction and Hernia M N/A N/A N/A 7 9 4 F 7 5 10 Cirrhosis of Liver M ) 8 6 5 7 5 2 F ) 0 0 0 4 6 2 Other Diseases of Digestive System M ) N/A N/A N/A 9 20 12 F ) 25 15 19 Nephritis and Nephrosis M N/A N/A N/A 7 4 7 F 4 2 8 Hyperplasia of Prostate M 12 12 13 8 6 3 F 0 0 0 0 0 0 Other Diseases, Genibto-Urinary System M N/A N/A N/A 8 8 10 F 8 15 15 Other Complications of Pregnancy, Etc. M N/A N/A N/A 0 0 0 F 0 1 2 Diseases of Musculo-Skeletal System M N/A N/A N/A 5 5 2 F 8 7 12 Congenital Anomalies M 17 10 17 11 12 9 F 14 14 13 17 9 17 Birth Injury, Difficult Labour, Etc. M N/A N/A N/A 9 13 12 F 10 7 8 Other Causes of Perinatal Mortality M N/A N/A N/A 23 12 15 F 13 9 14 Symptoms and 111 Defined Conditions M N/A N/A N/A 3 4 0 F 10 11 11 Motor Vehicle Accidents M 25 27 11 20 18 9 F 16 12 12 9 13 8 All Other Accidents M 18 28 24 34 27 18 F 22 17 24 24 19 24 Suicide and Self-inflicted Injuries M 24 14 15 22 19 18 F 12 14 6 10 9 9 All Other External Causes M N/A N/A N/A 2 5 4 F 1 2 1 Other Infective and Parasitic Diseases M N/A N/A N/A 0 ,0 3 F 3 0 1 Meningitis M N/A N/A N/A 3 0 1 F 1 0 0 62 Causes of Death Sex 1965 1966 1967 1968 1969 1970 Multiple Sclerosis M N/A N/A N/A 0 0 0 F 0 0 3 Whooping Cough M 0 0 0 1 0 0 F 0 0 0 0 0 0 Diseases of Skin, Subcutaneous Tissue M N/A N/A N/A 0 0 1 F 0 0 2 Other Defined Causes M ) F ) 1231 1212 ll6l - - - TOTAL ALL CAUSES M 1546 1572 1422 1498 1562 1406 F 1333 1315 1286 1398 1371 1315 63 INDEX Page Nos. A Adult Training Centres 33, 35 Ante-Natal Clinics 18, 49 Anthrax 9 Area of Borough 7 Artificial Kidney Machines 21 Attachment to General Practitioners l6, 26 B Bacteriological Examination - Pood 39 B.C.G. Vaccination 58 Births 1, 46 Brucellosis 9 C Cancer 60 Cervical Cytology 20 Chest Clinics 11 Chief Public Health Inspector's Report 39 Child Health Service 25 Child Minders 17, 54 Child Welfare Clinics 26, 49 Chiropody 20 Clean Air 40 Community Nursing School 19 Congenital Defects 25 D Day Centres (Mental Health) 33 Day Nurseries l6, 54 Deaths 7, 48, 60 Dental Services 29, 30, 50 Developmental Assessment Clinic 26 Diphtheria 9 64 Page Nos. D (Contd. ) Disinfeotion/Disinfestation 41 District Nursing 16 Domestic Help Service 21, 54 Dyslexia Unit 28 E Educationally Sub-Normal Children 31 Environmental Health Services 39 F & G Family Planning 20 Food and Drugs 39 Food Hygiene 39 Food - Imported 39 Food - Unsound 39 Food Poisoning 9 H & I Handicapped Pupils 27, 34 Handicap Register 25 Health Committee 2 Health Education 22 Health Visiting 15, 53 Home Help Service 21, 54 Home Nursing 54 Houses in Multiple Occupation 41 Housing 42 Immunisation 12 Improvement Grants and Areas 42 Incontinence Pads 22 Infant Mortality 7, 47 Infectious Diseases 8, 9, 10, 11, 12, 48 Infective Jaundice 10 65 Page Nos. J & K Junior Training School 34, 35 L Laundry Service 22 Legal Proceedings 58 Liaison with Hospitals 16, 26 Loan of Nursing Equipment 22 M Malaria 10 Maternal Mortality 7, 47 Measles 10 Meat Inspection 39 Medical Inspection of Schoolchildren 26, 50 Mental Health 33, Midwifery 17, 53 Minor Ailments 51 N Neo-Natal Mortality 47 Notices Served by Public Health Inspectors 59 Nursing Equipment - Loan of 22 0 Observation Register 25 Offensive Businesses 41 Offices, Shops and Railway Premises 40 P & Q Paratyphoid 11 Peri-natal Mortality 47 Personal Health Services 15 Pest Control 41 Phenylketonuria 52 66 Page Nos. P & Q (Contd.) Physiotherapy 28, 29 Playgroups 54 Poliomyelitis 10 Population 7 Post Natal Clinics 49 Principal Nursing Officer's Report 15 Principal Medical Officer's Report 25 Public Health Inspectors - Visits 58 R Removal of Persons in Need of Care 21 Renal Dialysis 21 Rent Act 39 Rodent Control 41 S Scabies 51 School Dental Service 52 School Health Service 26, 50 Sewerage 40 Slum Clearance 42 Smallpox 11 Social Conditions of the Area 7 Special Care Units 27 Speech therapy 28 Staff 4 Statistics and Social Conditions 7 Swimming Baths 40 T Tuberculosis 11 Typhoid 11 67 Page Nos. U Unmarried Mothers 55 V Vaccination 12, 57 Venereal Diseases 12 Verminous Schoolchildren 50 W Water Supply 40 Whooping Cough 12 68