AC.4413(1) AC43389L LONDON BOROUGH OF SUTTON HEALTH AND FAMILY SERVICES IN SUTTON Incorporating the Statutory Reports of Medical Officer of Health 1968 & 1969 Principal School Medical Officer P. Westcombe MB BS DPH Director of Health and Family Services and Medical Officer of Health HEALTH & FAMILY SERVICES IN SUTTON 1968/69 CORRIGENDA Page 37 In the last paragraph for "if" read "of". Page 44 Delete Symtomatic, Read Symptomatic Page 67 Health. Education - fifth, line for "an" read "and". Page 81 Speech Therapy - statistical information should read ""by Speech. Therapy" Page 125 Summary of Complaints and Work Done Delete 6,192 read 11,331 " " Last paragraph - delete Seventeen thousand, eight hundred and five inspections and re-inspections read Thirty-Seven thousand and forty-five inspections and re-inspections Page 127 First paragraph - Delete Six hundred and fifty three notices Read One thousand, four hundred and sixteen. CONTENTS INTRODUCTION PART I GENERAL STATISTICS AND SOCIAL CONDITIONS PART II EPIDEMIOLOGY PART III HEALTH SERVICES DIVISION Personal and School Health Services Environmental Health Services PART IV SOCIAL SERVICES DIVISION PART V HOUSING DIVISION PART VI ADMINISTRATION DIVISION (The Annual Reports of the Chief Inspector of Weights and Measures have been submitted as separate documents, these being the reports of the work of the Joint Weights and Measures Inspectorate with the London Boroughs of Kingston and Merton). Unless stated otherwise figures in brackets are for the year 19&7 _ 1 - MEMBERS OF COMMITTEES AS AT HAY 1968 (PRIOR TO RE-ORGANISATION) HOUSING COMMITTEE MEMBERS Councillor M.Curtis (Chairman) Councillor P.Bishop (Vice-Chairman) The Worshipful the Mayor, Councillor Leslie John Hill Alderman J.L.Bott, O.B.E. Councillors: G.Ballard P.J.Bassett J.Buck (Mrs) F.Cockerill J.C.Cox H.Ferguson, F.C.A., J.P. H. Fox M.R.Grimes (Mrs) H.Haydon J.McMahon K.J.Martin E.G.Trevor, F.A.I., A.R.V.A. CHILDREN'S COMMITTEE Councillor K.J.Martin (Chairman) Councillor Mrs,M.R.Grimes (Vice-Chairman) The Worshipful the Mayor, Councillor Leslie John Hill Alderman J.L.Bott, O.B.E. Councillors: F.A.Blackler (Miss) B.Sc. E.W.Goodall H.O.Judd (Mrs.) M.A., J.P. A.J.Kenney E.C.Marshall E.G.Mason R.J.Slater P.S.Tucker Co-opted Members: Mr.Green, Mrs.Heath, Mrs.Newton, Mr.Whitehouse HEALTH COMMITTEE Councillor N.F.Paul (Chairman) Councillor G.F.Everitt, J.P. (Vice-Chairman) The Worshipful the Mayor, Councillor Leslie John Hill Alderman S.J.Barton, J.P. Councillors: J.Buck (Mrs) F.S.Dixon B.C.Fleming H.Fox H.O.Judd (Mrs) M.A., J.P. A.J.Kenney D.P.Madden D.H.T.Salari, J.P. N.G.Shelley H.Sunderland Co-opted Members: Miss Bates, Miss Bomford, Dr.Ison, Dr.Lawson and Dr0Potter. - 2 - WELFARE COMMITTEE Councillor P.Bishop (Chairman) Councillor F.S.Dixon (Vice-Chairman) The Worshipful the Mayor, Councillor Leslie John Hill Alderman S.J.Barton, J.P. Councillors: F.A.Blackler (Miss) B.Sc. J.Buck (Mrs) JeDowsett, J.P. C.R.C.Fenson E.W.Harding H.O.Judd (Mrs) M.A., J.P. W.D.Milne J.J.Nicholls, B.Sco, F.R.I.C. N.F.Paul I.S.E.Tomlin (Miss) J.P. A.R.Wakefield Co-opted Members: Mr.Bailey, Mr.Barker, Mr.Day, Mrs.Haydon and Mrs0Pettingell - 3 - MEMBERS OF COMMITTEES AS AT 51ST DECEMBER 1968 CHILDREN'S COMMITTEE Councillor K.J.Martin (Chairman) Councillor N.F.Paul (Vice-Chairman) The Worshipful the Mayor, Alderman F.C.Finch J.P. Aldermen: J.L.Bott, O.B.E. A.G.Taylor Councillors: L.R.G.Brown J.W.Dunn G.Eve G.F.Everitt J.P. E.W.Goodall J.L.Izard R.J.Jordan, B.Sc.(Lond) R.J.Slater, A.A.I., A.R.V.A. R.C.Squire, A.C.A. Co-opted Members: Mrs.Driscoll, Mrs.Heath, Mrs.Zaiger. HEALTH & FAMILY SERVICES COMMITTEE Councillor K.J.Martin (Chairman) Councillor N.F.Paul (Vice-Chairman) The Worshipful the Mayor, Alderman F.C.Finch, J.P. Aldermen: J.L.Bott, O.B.E. A.G.Taylor Councillors: L.R.G.Brown J.W.Dunn G.Eve G.F.Everitt, J.P. E.W.Goodall J.L.Izard R.J.Jordan, B.Sc.(Lond) R.J.Slater, A.A.I., A.S.V.A. R.CoSquxre, A.C.A. Co-opted Members: Mrs.Buck, Mrs.Haydon, Mr.Dixon, Dr.Lawson -4- MEMBERS OF COMMITTEES AS AT 31ST DECEMBER 1969 CHILDREN'S COMMITTEE Councillor KoJoMartin (Chairman) Councillor F. Knights (Vice-Chairman) The Worshipful the Mayor. Councillor F.GoMoore Aldermen: J.L.Bott, 0.BoE. AoGoTaylor Councillors: LoRoGoBrown J.W.Dunn G.Eve G.F.Everitt, J.Po E.W.Goodall J.LoIzard N.F.Paul R.J.Slater, A.A.I., A.R.V.A. R.C.Squxre, A.C.A. Co-opted Members: MrsoDriscoll, Mrs.Heath, Mrs.Zaiger, Mr.Kenney HEALTH AND FAMILY SERVICES COMMITTEE Councillor KoJoMartin (Chairman) Councillor FoKnights (Vice-Chairman) The Worshipful the Mayor, Councillor FoGoMoore Aldermen: J.L.Bott, 0.B.E. A.G.Taylor Councillors: LoRoGoBrown J.W.Dunn G.Eve G.F.Everitt, J.P. E.W.Goodall J.L.Izard NoFoPaul RoJoSlater, A.A.I., A.R.V.A. R.C.Squire, A.C.A. Co-opted Members: Mrs.Buck, Mrs.Haydon, Dr.Heywood, Mr.Kenney, Dr.Lawson - 5 - To The Worshipful the Mayor, Aldermen and Members of the Council. Mr.Mayor, Ladies and Gentlemen, Because of the exceptionally heavy demands upon staff time and resources I regret it has not been possible to produce annual reports of the Medical Officer of Health at the customary times. This report, therefore, covers the two years 1968 and 1969 during which major departmental changes took place and is presented as a departmental report which incorporates the statutory Medical Officer of Health's report. Historical In 1968 the Council, as part of the general re-organisation of its committee and departmental structure, combined the previously separate Health and Welfare, Children's and Housing Departments into a single department to be called The Health and Family Services Department which was made responsible for "the personal well-being, both physical and mental, of people of all ages and conditions including environmental health and public control". The Council decided that the new department should comprise Health (Personal, School and Environmental); Welfare; Children's; Housing; and Administration sections and that when the report of the Seebohm Committee was received, the structure of the department should be further considered. Following publication of the Seebohm Report, the Welfare and Children's Sections were amalgamated into a single Social Services Section which also incorporated certain social services transferred from health administration. Within the combined department, therefore, with the exception of the Mental Health Service which was closely aligned to hospitals; day nurseries and child minders, for which social worker staff was not available; home help, closely aligned to Nursing and Midwifery Services; a Seebohm-type social services organisation was established headed by a Chief Social Services Officer. It was the expressed intent of the Council to transfer further responsibilities to the Social Services Section when it became possible to do so. The wisdom of delaying such transfers became apparent with the emergence of major personal and organisational difficulties when a start was made in integrating social work on a generic basis as envisaged by the Seebohm Committee. The first stage of this development was to allocate social workers to four area teams which incorporated Child Care, Intensive Family Case Work and National Assistance Act responsibilities. The teams were supported by a consultative middle-management structure in each of the specialities. Unfortunately many staff changes took place, a situation which continued until early 1970 and which very considerably impeded progress. Certain professional organisations were unable to support the policy of the Council which they publicly opposed. There was thus a highly charged emotional and "politicoprofessional" atmosphere and it is a great tribute to those members of staff who stood firm against the pressures they experienced and continued to serve the Council with unswerving loyalty. - 6 - I am glad to report that this position has now improved beyond all measure and that much progress has been made in recent months towards a fuller implementation of the Council's policy. It has not yet been possible to provide local offices for area teams because of the difficulty of finding suitable accommodation for them. Some social workers still do not feel equipped by training or experience to adopt a generic role, though many are now coming closer to this concept. The re-organisation of departments affected not only the work of social services but all sections of the department. It involved much transfer of office accommodation, major changes in administrative procedures and control, and changes in function and status for personnel. The London Boroughs Management Services Unit had previously conducted surveys of organisation and methods within each of the sections of the new Department and many of the Unit's recommendations were being implemented during this period. With the transfer of responsibility for housing rent collection to the Borough Treasurer's Department, and for the maintenance of Council houses to the Borough Architect's Department, the Housing Department, now responsible for housing letting and management, rent rebates and arrears recovery, became a division of the Health and Family Services Departmen.* The Environmental Health Section became responsible for public control functions previously undertaken in the Town Clerk's Department,, In order to allow closer alignment of like functions the Chief Public Health Inspector's staff were moved from their offices at Wallington Town Hall to The Lodge, Carshalton, where they were accommodated together with the Housing Manager"s staff. This enabled the staff of the Children's Department to move to Wallington Town Hall where, by internal adjustments to the allocation of offices between sections, the new Social Services Division (as it came to be called) occupied the whole of the ground floor. The Administration Section became responsible for central management service to all sections, each of which maintained the sectional clerical/administrative staff necessary to support the field work within its own periphery. Housing With a large number of houses and flats becoming available for letting at Roundshaw and on other estates it has been possible to deal with many families who vere in serious housing need. With committees having the same membership responsible for Council Housing and Health and Social Services, it has been possible to support that minority of tenants who are socially and medically disabled more effectively and to weigh in each case all the factors contributing to each situation and to deteimine action accordingly. This has undoubtedly led to emphasis being placed upon the broader welfare of these families. It has, however, added to the difficulties of the Housing Manager and his staff in ensuring that the Council's reasonable conditions of tenancy are met, with the result that there has been a steady increase in the number of cases of rent arrears. In reviewing the position generally there can be no doubt of the benefit to Health and Social Services from a close association with housing functions though it does not necessarily follow that the reverse is true. - 7 - It remains a source of pride that at the time of writing no child has been received into the care of the Authority on account solely of eviction from Council property, while many families who would have previously been homeless are being sustained in peimanent housing or long-term rehabilitation units, albeit at not insignificant cost. It has further been possible to discharge a number of children from the care of the Council and to permanently re-house families from temporary accommodation and long-term rehabilitation units. Much work has been done to assess the Housing circumstances in the Borough generally. The position was reviewed in a report to the Council in November 1969 which incorporated not only an assessment of the requirements for building new Council houses, but also a preliminary review of the state of existing dwellings in the private and public sectors. Important policy decisions were subsequently adopted by the Council as follows:- (a) That the current Council policy of making a contribution to the housing needs of Greater London, as well as Sutton, be re-affirmed. (b) That loans for house purchase continue to be made by the Council to the widest possible extent. (c) That for the time being the present policy of not selling Council dwellings built to let except in very special cases be maintained. (d) That the sale of Council-owned land for private housing be agreed wherever this does not prejudice the Council's own future land requirements but the sale of such land to other local authorities be agreed only in exceptional cases. (e) That, subject to review annually, the building of further dwellings to let in accordance with the estimated housing needs referred to above be approved and, in the programme, priority be given to building for health and welfare needs. (f) That the activities of Housing Associations be further encouraged by making loans and grants to them for general as well as specialised housing needs and by making land available for development by Housing Associations, particularly where the Council are in a better position to purchase the land and combine small parcels of land into larger areas suitable for residential development. (g) That more positive and vigorous steps be taken to increase the use of loans and improvement grants to (l) add to the existing stock of dwellings by conversions and (2) conserve the existing stock of dwellings by the provision of the standard amenities. (h) That a more positive and vigorous policy with regard to under-occupation be adopted. - 8 - (i) That miscellaneous properties owned by the Council "be used as far as practicable to meet the general needs of families on the Council's housing waiting list. (j) That each application for housing by the Council be examined to see if the need can be met in some other way than by letting Council accommodation,, Ways of implementing these decisions are now being considered by appropriate Committees and Departments following discussion of the general policy proposed with the Tenants' Consultative Committee. Whatever the final form of the Council's on-going housing programme, there is no doubt that for successful implementation and to accord with the views of the Seebohm Committee and the Housing Management Sub-Committee of the Central Housing Advisory Committee, the closely co-ordinated work from which the final policy report emerged must continue., Housing needs in the Borough must be dealt with as a single entity which embraces the planning and provision of new Council-owned and privately-owned property; maintenance of existing housing stock in a satisfactory state of repair and by the provision of basic amenities in both the public and private sectors; recognition of the exceptional social problems of a minority of housing applicants which cannot be alleviated solely by the provision of a Council house; the relief of an increasing number of elderly persons who under-occupy over-large accommodation; the provision of adequate supporting services for the sick, the handicapped and elderly coincidental with housing development; and on the broader canvas, recognition of the needs of families beyond the single provision of somewhere to live, they also need somewhere to work, to achieve satisfying leisure activities, somewhere to serve and all at a price they can afford to pay. I am increasingly concerned by the number of families who, particularly at the beginning of married life, become committed to rents or mortgage payments which are really beyond their financial resources or potential, a situation which not infrequently leads them towards social and mental ill-health, still further loss of earning capacity and progress towards eventual homelessnesso Not all reach this final destination but these families really need to be able to rent or purchase houses or flats which provide the basic requirements for family living, the price of which they can afford, leaving the desirable though not essential costly refinements to be added when they can afford to pay for them. I pass this financial and architectural conundrum on to those better qualified to solve it than I. Infectious Disease Prevention and control of infectious disease while calling for little exceptional report in these pages, continues to be an important function of Health Services,, Reference is made in the body of the report to the introduction of vaccination against measles and the customary statistics relating to notification, vaccination and immunisation generally are to be found. It is a matter of congratulation to Sutton's parents that the percentage of children immunised against diphtheria, whooping cough and poliomyelitis in 1969 as determined by the Department of Health and Social Security has risen to 95% of children born in 1967, a figure as high as for any area in the country. I hope it will be possible to record a similar high uptake for measles vaccination in my next report. - 9 - Notifications of new cases of venereal disease show a marked increase for 1969. This trend is to he noted nationally and, indeed, internationally. It presents a serious challenge to parents, teachers and health educationalists to see that young people are properly informed of the physical and moral danger of extramarital sexual intercourse and promiscuous sexual behaviour. The fear of unwanted pregnancy has largely been dissipated by the advent of modern contraceptive methods and is no longer a deterrent to promiscuous behaviour. Venereal diseases are transmitted by intimate sexual contact and those who have placed themselves at risk should present themselves for examination by either their family doctor or at one of the special venereal disease clinics where they will be treated with kindness and without the adoption of moral attitudes. Personal Health The Council's personal and school health services have made much progress towards their closer alignment with general practitioners and hospitals. Health visitors and home nurses and midwives are being attached to groups of general practitioners wherever possible and enjoy increasingly closer association with local hospitals. The achievement of full integration cannot be achieved quickly; it inevitably requires more staff and many administrative and professional problems have to be overcome. It is important to ensure that the much valued preventive work carried on in schools and health clinics by doctors, health, visitors and nurses does not suffer during the progress of unification, whether this be on a national or local basis; also that the new sphere in which attached nursing staff are asked to work does not detract from their traditional form of service to families in their own homes. The report of the Chief Medical Officer illustrates the continually increasing demand for community health services of all sorts. Particular note should perhaps be made of developments in the fields of Family Planning, Cervical Cytology and well-women screening, screening of infants for phenylketonuria and fibrocystic disease of the pancreas and of advisory clinics for the elderly. These developments in special fields of work should not be allowed to overshadow the importance of family visiting and routine procedures of health supervision for mothers and children which are the basis of preventive health services. Attention should also be drawn to the increasing numbers of sick, elderly and disabled persons being nursed in their own homes and of maternity cases delivered in hospital who are discharged early to their own homes. Environmental Pollution This subject is one to which, quite rightly, a great deal of public attention has been drawn in recent times. It should not be thought, however, that this is a new problem or one over which there is no control at present. The report of the Chief Public Health Inspector describing the work of the Public Health Inspectors is illustrative of the extent of the work which is carried out routinely in connection with those aspects of pollution control for which local authorities are responsible. In comparatively few cases is enforcement action necessary, most are resolved by education and persuasion. - 10 - Staff,Training and other Activities I referred in my report for 1967 to the greatly increased demand for all your health and welfare services which had been experienced since 1965 and this trend has continued. It seems also to have "been greatly accelerated by the amalgamation of departments, resulting from greatly increased ease of reference from one section to another and greater co-ordination of effort. The growth rate of the field staff establishment which was incorporated in the Council's three-year projection for the department has been overtaken by the rate at which demands for services have risen. Much additional work including some transferred from other departments, has been absorbed by improved methods particularly in the administrative/clerical field, in which savings have been made. New legislation continues to impose additional responsibilities and preventive work in all fields has been limited by the availability of staff time and financial restriction. None-the-less much progress has been made in all fields as will be seen from the divisional reports which follow. The bulk of this report deals with items of service provided by experienced or trained and qualified members of staff of many different professions at varying stages of their careers. A not insignificant proportion of staff resources is, however, deployed at any one time in achieving professional or vocational training by secondment to courses at colleges and universities or by in-service training in the form of day release, evening, correspondence courses. Particular emphasis has been placed on training in the skills or management, both senior operational and administrative/clerical staff participating. Many members of staff have attended specialised courses of a post-graduate type to equip them for dealing with particular specialised aspects of their work. There is thus a gradually increasing amount of expertise being built up within the department, and the recurrent stimulus of staff returning from training courses introducing new ideas and methods is very beneficial. Staff of the department are also much engaged in the activities of voluntary and statutory agencies in the Borough and through the London Boroughs Association in Greater London generally. Although this is a highly desirable state of affairs it has the inevitable result of reducing the day by day effective man and woman power of the department to an extent which has on occasion resulted in real staff shortage. Health and Family Services have in the recent past been the object of much public examination, internal and external re-organisation. Nov/ that the Social Services Act is on the statute book and proposals for re-organised Health Services at an advanced state of consideration, it is to be earnestly hoped that they will be permitted to enter a period of stability which will enable them to develop their work with the whole of their resources, whatever the final administrative organisation may be. If I may be permitted to forecast the future, I see social services developing upon much the same lines as have Local Health Authority services since their inception. - 11 - Area based social work offices and teams will develop in the same way as did local health clinics and their doctors and health visitors and nurses - at first in church halls, scout huts or any premises which can he found. Those engaged in social services must not at first set their sights too high; the most effective service is more often born out of difficulties than easy labour. Real status is not gained by administrative decisions but through providing effective service. The niceties of theory and academic study must give way to practical means of providing help where it is needed and at the time it is needed if social services are to fulfil the tasks envisaged for them. The fire brigade type of service at present provided to meet emergency situations and acute social distress will be maintained, but will gradually be reinforced by greater emphasis on preventive work the basis of which is education and family visiting similar to that now practised by preventive health services. If effective family service is to be maintained and developed it will be necessary for the close personal relationships which have grown within the Department since its inception to be maintained between all those responsible, whatever their professional calling or departmental allegiance. In Sutton the experience of the last two years has done much to ensure that this will be the case. The foundations of your new Social Services Department have been laid and I have every confidence that in their separate but closely parallel roles, Family Health and Social Services will in the future continue to provide a high standard of service. P.WESTCGMBE, M.B. ,B.S. ,D.P.H. , Medical Officer of Health Director of Health & Family Services GENERAL STATISTICS AND PART I SOCIAL CONDITIONS INDEX Page No. AREA AND POPULATION 14 DEATHS 19 BIRTHS 29 VITAL STATISTICS 31 P WESTCOMBE MB BS DPH Medical Officer of Health - 13 - AREA AMD POPULATION Population tables are again reproduced in some detail. Although not necessarily up-to-date they contain the most recent information available for the Borough and it was felt appropriate to include them in their present form to provide readily accessible information and for purposes of comparison in subsequent reports. Care should be exercised in comparing one table with another to differentiate between Census figures and Registrar General's' estimates. Over the past few years the rate of fall of the population of the Borough has been slowing. Statistics for the last two years indicate a reversal of the previous trend, the population having increased, doubtless due to the effect of new building at Roundshaw. Area Census Population Registrar General's Estimate of mid-year in population Acres 1951 165 1966 1967 1968 1969 10732 176151 169095 167820 166790 165840 165250 165430 166430 Population by Age Groups Registrar General's Estimate of Mid-Year Population. Under 1 year 1-4 years 5-14 years 15-64 years 65 years and over Total all ages 1969 2260 9740 22600 109050 22800 166430 1968 2370 9830 21900 108650 22700 165430 1967 2420 9780 21200 108690 23160 165250 - 14 - Population by Sex and Aee - 10% Census 1966 (in brackets Census 1961) Age Males Females Total 0-4 6480 (5466) 5700 (5179) 12180 (10645) 5-9 5780 (5119) 5430 (4941) 11210 (10070) 10 - 14 4830 (6638) 5140 (6412) 9970 (13050) 15 - 19 6090 (5703) 5660 (5937) 11750 (11640) 20 - 24 5140 (4459) 5250 (5151) 10390 (9610) 25 - 29 4550 (4760) 4980 (4855) 9530 (9615) 30 - 34 4870 (4848) 4980 (5275) 9850 (10123) 35 - 39 4790 (5388) 5150 (5992) 9940 (11380) 40 - 44 5310 (4982) 6060 (5659) 11370 (10641) 45 - 49 4880 (5875) 5160 (6807) 10040 (12682) 50 - 54 5290 (6550) 6150 (7537) 11440 (14087) 55 - 59 6020 (6492) 7010 (7203) 13030 (13695) 60 - 64 5470 (4832) 6210 (5935) 11680 (10767 65 - 69 3480 (3229) 5040 (4456) 8520 ) (7685) ) 70 - 74 2340 (2004) 3840 (3467) 6180 ) 22810 (5471) ) 21090 75 + 2650 (2523) 5460 (5411) 8110 ) (7934) ) Total 77970(78868) 87220(90227) 165190 (169095) % of Total 60 - 64 7.02 (6.12) 7.12 (6.58) 7.07 (6.3) 65 - 69 4.44 (4.00) 5.78 (4.94) 5.16 ) * (4.54) 70 - 74 3.00 (2.54) 4.40 (3.84) 3.74 )13.81% (3.23) 12.48% 75 + 3.40 (3.32) 6.26 (5.99) 6.18 ) (4.69) * Residents aged over 65 Projections of population trends are notoriously difficult to forecast with any accuracy and the hazards of comparing census figures (1961) covering the whole population with the census figures (1966) covering only 10% of the population are obvious. Nevertheless the trends illustrated by the above tables indicate significant increases in the population groups aged 0 — 9 and those over 65 years of age. In 1961 12 .48% of the population was aged over 60 and on the 10% sample figures 1966 13.81%. These figures are in accordance with the national trend and their significance is real when considering services for the vulnerable age groups of the population generally. - 15 - Rateable Value 1st April 1967 1st April 1968 1st April 1969 £9,63,483 £9,829,493 £10,041,243 Estimated net product of a penn.v rate 1966/67 1967/68 1968/69 £39,050 £39,487 £40,520 Estimated number of Separately assessed properties 64,108 65,168 66,559 - 16 - Acreage, Population, Private Households and Dwellings - 10% Census 1966 Area Acreage Population Private households and dwellings. 10% Census 1966 Total Persons Males Females Persons per acre for the London Borough of Sutton Private households Population in private households Structurally separate dwellings occupied Rooms Occupied Density of occupation Persons per room % of Persons at more than l½ per room Beddington Nth 706 5,680 2,850 2,830 15.05 1,830 5,680 1,870 10,430 0.43 2.5 Beddington Sth 849 7,390 3,690 3,700 2,480 7,390 2,540 15,170 0.49 0.54 Belmont 500 6,960 2,920 4,040 2,130 6,030 2,150 12,440 0.56 1.3 Carshalton Cent. 320 5,440 2,520 2,920 1,690 5,190 1,630 9,640 0.56 1.8 Carshalton N.E. 330 8,500 4,270 4,230 2,910 8,500 2,940 14,450 0.59 5.53 Carshalton N.W. 255 7,670 3,690 3,980 2,630 7,670 2,420 13,930 0.55 3.8 Carshalton S.E. 1,411 8,650 3,920 4,730 2,520 7,710 2,520 14,090 0.62 2.4 Carshalton S.W. 448 6,500 3,070 3,430 2,080 6,380 2,030 12,310 0.53 1.2 Carshalton St.Helier N. 249 6,230 3,000 3,230 2,160 6,090 2,180 9,460 0.66 6.38 St. Helier S. 122 6,130 2,940 3,190 1,690 5,270 1,690 7,680 0.80 3.26 St. Helier W. 211 6,020 2,890 3,130 2,110 6,020 2,190 9,920 0.61 3.32 Cheam N. 251 6,690 3,34o 3,350 2,340 6,690 2,370 13,220 0.51 0.15 Cheam S. 866 7,060 3,810 3,630 2,210 6,840 2,360 14,710 0.50 1.42 Cheam Wo 241 5,840 2,840 3,000 2,060 5,840 2,110 11,710 0.50 0.17 Sutton Cent. 203 5,200 2,520 2,680 1,900 5,200 1,900 9,950 0.52 0.19 Sutton East 342 5,030 2,360 2,670 1,900 5,030 1,720 9,130 0.55 4.77 Sutton North 437 6,100 2,890 3,210 2,070 6,100 2,070 11,400 0.54 1.31 Sutton N.E. 542 7,290 3,540 3,750 2,490 7,290 2,520 13,250 0.55 0.83 Sutton S.E. 361 5,100 2,250 2,850 1,920 5,030 1,760 10,930 0.47 2.35 Wallington Cent. 144 6,500 2,950 3,550 2,300 6,46o 2,340 12,550 0.52 0.15 Wallington N 362 5,360 2,540 2,820 1,810 5,360 1,780 9,740 0.55 1.67 Wallington S 369 l,400 3,460 3,940 2,500 7,260 2,300 14,310 0.52 1.49 Worcester Park N 407 8,620 4,020 4,600 2,810 8,220 2,820 15,030 0.57 6.38 Worcester Park S 310 6,700 3,120 3,580 2,320 6,700 2,370 13,110 0.51 0.15 Sutton South 712 7,130 3,130 4,000 2,580 7,070 2,420 13,360 0.53 1.68 TOTAL 10,948 159,190 78,530 87,040 55,440 161,020 55,000 301,920 - 17 - Acreage, Population, Private Households and Dwellings - Census 1961 Area Acreage Population Private households and dwellings. 1961 1951 1961 Private households Population in private households Structurally separate dwellings occupied Rooms occupied Density of occupation Persons Persons Males Females Persons per acre Persons per room % of Persons at more than 1½ per room Beddington Wallington M.B 3,045 32,757 32,603 15,227 17,376 10.7 10,927 32,456 10,354 54,685 0.60 1.8 Wards Nos. 1 Beddington Nth 706 5,338 5,205 2,534 2,671 7.4 1,638 5,205 1,625 7,715 0.68 2.6 2 Beddington West 458 3,633 3,680 1,735 1,945 8.0 1,243 3,677 1,174 6,233 0.60 1.7 3 Beddington Cent. 157 4,829 4,436 2,072 2,364 28.3 1,510 4,436 1,431 7,030 0.64 2.2 4 Beddington Sth 849 5,454 5,998 2,841 3,157 7.1 1,916 5,960 1,877 10,839 O.56 0.3 5 Wallington Nth 362 5,235 4,918 2,392 2,526 13.6 1,653 4,918 1,606 7,729 0.64 2.7 6 Wallington Cent. 144 4,049 3,726 1,667 2,059 25.9 l,406 3,701 1,260 6,504 0.58 1.1 7 Wallington Sth 369 4,219 4,640 1,986 2,654 12.6 1,561 4,559 1,381 8,635 0.54 1.8 Carshalton U.D. 3,346 62,721 57,484 27,226 30,258 17.2 17,952 55,254 17,545 81,531 0.69 4.7 Wards: Central 320 5,964 5,725 2,472 3,253 17.9 1,912 5,459 1,807 9,348 0.59 1.8 North East 330 9,940 8,949 4,418 4,531 27.1 2,877 8,925 2,812 12,490 0.72 4.8 North West 255 7,419 6,761 3,171 3,590 26.5 2,298 6,735 2,230 11,030 0.62 1.5 St.Helier North 249 8,624 7,021 3,498 3,523 28.2 2,187 6,861 2,172 8,173 0.85 10.6 St.Helier South 122 7,710 6,211 2,891 3,320 50.9 1,718 5,352 1,698 6,528 0.83 7.6 St.Helier West 211 8,064 6,606 3,295 3,311 31.3 2,118 6,593 2,086 8,183 0.81 7.8 South East 1,411 8,630 9,113 4,243 4,870 6.5 2,536 8,294 2,492 12,655 0.66 3.1 South West 488 6,370 7,098 3,238 3,860 15.8 2,306 7,035 2,248 13,124 0.55 0.8 Sutton & Cheam MB 4,338 80,673 79,008 36,415 42,593 18.2 26,630 77,200 25,492 128,938 0.6l 2.5 Wards Nos. 1 or North West 364 8,237 8,182 3,842 4,340 22.5 2,869 8,182 2,800 12,974 0.59 0.8 2 or North 437 10,232 9,454 4,391 5,063 21.6 3,104 9,114 3,048 14,264 0.65 3.6 3 or North East 542 11,609 10,772 5,192 5,580 19.9 3,582 10,763 3,488 16,598 0.66 3.4 4 or East 342 7,892 8,239 3,890 4,349 24.1 2,830 8,219 2,621 32,632 0.66 4.9 5 or South East 361 6,231 6,081 2,621 3,460 16.8 2,264 5,945 2,054 10,777 0.57 2.1 6 or South 712 9,720 10,007 4,186 5,821 14.1 3,306 8,956 2,980 16,271 0.57 3.0 7 or South West 890 6,329 7,827 3,455 4,372 8.8 2,502 7,588 2,482 14,591 0.53 0.4 8 or East Central 285 7,571 6,793 3,216 3,577 23.8 2,294 6,780 2,237 11,062 0.62 2.4 9 or West Central 405 12,852 11,653 5,622 6,031 28.8 2,879 11,653 3,782 18,769 0.63 1.4 Socio-economic grouping (Males and Females) from 10ft Census 1966 Percentage 1. Professional workers 5.96 2. Employers managers 12.37 3. Other self-employed 3.8l 4. Skilled workers 19.05 5. Non-manual workers 38.77 6. Service, semi-skilled, agricultural 14.84 7. Armed Forces .29 8. Unskilled 4.87 - 19 - Causes of death at different periods of life during 1968 (Figures in brackets are for 1967) Cause of Death Sex Total all Ages Under 4 Weeks 4 weeks & under 1 year 1- 5- 15- AGE IN YEARS 65- 75 & over 25- 35- 45- 55- B 4 Enteritis & other Diarrhoeal Diseases M 2 (3) — 2 - - - - - - - - - F - (8) — — - - - - - - - - - B 5 Tuberculosis of Respiratory System M 1 (7) - - - - - - - - - - - P 4 (2) - — - - - - - 2 1 - 1 B 6 Other Tuberculosis, incl.Late Effects M 2 (1) - - - - - - - - 1 - - F 2 (-) - - — — - - - 1 1 1 1 Bll Meningococcal Infection M 1 — — - - - 1 - - - - - F - - — - - - - - - - - - B17 Syphilis and its Sequelae M 2 (l) - - - - - - - - - - - F 1 (4) - - - - — - - l - 1 1 B18 Other Infective and Parasitic Diseases M 1 (2) - - - - - - 1 - - - - F - (2) - — - - - - - - - - - B19 (l) Malignant Neoplasm Stomach M 20 (21) — - - - - - - 1 4 10 5 F 18 (13) - - — — — - - 1 4 5 7 B19 (2) Malignant Neoplasm Lung, Bronchus M 92 (100) - — - - - - 8 30 45 9 F 21 (20) - - — — - - - 7 7 6 1 B19 (3) Malignant Neoplasm Breast M 2 (-) - - - - - - - 1 - 1 F 50 (34) - - - - - - 2 7 12 14 15 B19 (4) Malignant Neoplasm Uterus F 11 (15) - - - - - - 2 2 4 3 B19 (5) Leukaemia M 6 (4) - - 1 1 - - - - 3 1 - F 6 (5) - - - - 1 - 1 - 3 1 — B19 (6) Other Malignant Neoplasms, etc M 114 (108) - - - 2 - - 6 6 23 3 — F 99 (102) - — 1 1 1 1 10 23 47 29 B20 Benign and Unspecified Neoplasms M - - - - - - - - - 23 27 36 F l - - — — - - - - - 1 - B21 Diabetes Mellitus M 6 (7) - - - - - - - - 1 - - P 11 (9) - — - - - - 1 - 1 4 5 B46 (l) Other Endocrine etc. Diseases M — - - - - - - - - - 6 F 4 — - - - - - - - 3 — 1 B23 Anaemias M 1 — — - - - 1 - — F 5 - - - - - - - - — - 5 - 20 - Cause of Death Sex Total all Ages Under 4 Weeks 4 weeks & under 1 year AGE IN YEARS 1- 5- 15- 25- 35- 45- 55- 65- 75 & over B4 6 (3) Mental Disorders M — - - - - - - - - - - F 10 - - - - - - - - - 2 8 B24 Meningitis M 1 - - 1 - - - - - - - - F 1 - - = - - - - - 1 - - B46 (4) Other Diseases of Nervous System etc. M 3 - - - - - 1 - - - 1 1 F 13 - - - - 1 - - - l 3 8 B26 Chronic Rheumatic Heart Disease M 2 — — — - — - — - 1 1 - F 18 - - - - - - - 4 5 5 4 B27 Hypertensive Disease M 9 - - — — — — — 1 2 1 5 F 24 - - - - - - - - - 8 16 B28 Ischaemic Heart Disease M 290 — — — — — — 4 21 87 95 83 F 233 - - - - - - - 3 16 65 149 B29 Other forms of Heart Disease M 49 - - — — - 1 1 — 3 9 35 F 82 - - - - 1 - - 1 - 13 67 B30 Cerebrovascular Disease M 109 - - — l — — 1 6 13 27 61 F 199 - - - - - - 2 4 16 43 134 B46 (5) Other Disease of Circulatory System M 34 — — — — — — — 3 6 11 14 F 54 - - - - - - 1 1 3 10 39 B31 Influenza M 7 (1) - — — — — — — 1 3 — 3 F 9 (2) - - - - - - - - 1 1 7 B32 Pneumonia M 42 (42) — 2 1 — — — — — 6 11 22 F 81 (73) - - - - - - - - 3 14 64 B33 (l) Bronchitis & Emphysema M 69 (72) — — - - — — 1 1 20 24 23 F 24 (11) - - - - - - - - 3 6 15 B33 (2) Asthma M 4 - - - - 1 - - 2 - - 1 F 1 - - - - - - - - - 1 - B46 (6) Other diseases of Respiratory System M 3 (13) - - - - - - - 1 — - 2 F 6 (8) - - - - - - - 1 — 5 B34 Peptic Ulcer M 9 (4) - - - - - - - - 1 3 5 F 5 (7) — — — — — — — - = 1 4 B35 Appendicitis M - - - - - - - - - - - - F 1 - - - - - - - - - 1 - -'21 - Cause of Death Sex Total all Ages Under 4 Weeks 4 Weeks & under 1 year 1- 5- 15- AGE IN YEARS 65- 75 & Over 25" 35- 45- 55- B36 Intestinal Obstruction and Hernia M 6 - - - - - - - - - 4 2 F 3 - - - - - 1 - — l - 1 B37 Cirrhosis of Liver M 2 - - - - - - - 1 l - - F 1 - - - - - - - - - - 1 B46 (7) Other Diseases of Digestive System M 1 — — — - - - - - - - 1 F 11 - - - - - - - - 3 5 3 B38 Nephritis and. Nephrosis M 3 (6) - - - - - - - 1 - 1 1 P 3 (4) - - - - - - - 1 1 l - B39 Hyperplasia of Prostate M 8 (7) - - - - - - - - 1 2 5 B4 6 (8) Other Diseases, Genito-Urinary System M 6 - - - - - - - - 3 3 F 9 - - - - - - - - 2 1 6 B41 Other complications of Pregnancy, etc. F 1 - - - - 1 - - - - - - B46 (10) Diseases of Musculo-Skeletal System M 2 - - - - - - - - 2 - - F 4 - - - - - - - - 1 1 2 B42 Congenital Anomalies M 8 (6) 3 1 2 - - - - 1 - - 1 F 3 (6) 1 1 1 - - - - - - - - B43 Birth Injury, Difficult Labour etc. M 12 12 - - - - - - - - - - F 5 5 - - - - - - - - - - B44 Other causes of Perinatal Mortality M 5 5 - - - - - - - - - - F l 1 - - - - - - - - - - B45 Symptoms & Ill-Defined Conditions M 3 (53) - - - - - - - - - - 3 F 8 (68) - - - - - - - - - - 8 BE47 Motor Vehicle Accidents M 8 (14) - - - l 2 1 2 1 1 F 10 (9) - - 1 2 3 - - 1 1 2 BE48 All other Accidents M 10 (9) — — 2 — 1 - - 1 1 3 2 F 13 (17) - 1 - - - - 1 - - 1 10 BE49 Suicide & Selfinflicted Injuries M 13 (8) - - - - 1 2 1 1 2 5 1 F 7 (7) - - - - I 2 1 1 2 BE50 All Other External Causes M - - - - - - - - - - - — F 1 - - - - - - - - 1 - - TOTAL ALL CAUSES M 968 (965) 20 5 7 5 5 7 16 58 216 303 326 F 1074(l025) 7 2 2 3 8 2 11 44 115 249 631 -22- Causes of death at different periods of life during 1969 Causes of Death Sex Total all ages Under if weeks 4 Weeks & Under 1 year 1-4 5-14 15-24 25-3 35-44 45-54 55-64 65-74 75 & over Enteritis and Other Diarrhoeal Diseases M 2 - - 1 - - - - 1 - - F - - - - - — — — - — — — Tuberculosis of Respiratory System M 3 — — — - — — — — - 1 2 F 1 - - - - - - - - - 1 — Other Tuberculosis, incl. Late Effects M 5 — - - - - — — - 3 - 2 F - - - - — - - - — — — Syphilis and its Sequelae M 1 - — - - - - - - - 1 - F — — — — — — — — — — - — Other Infective and Parasitic Diseases M 3 — — - - 1 — — - — 2 — F 1 - — - - - - - - — — 1 Malignant Neoplasm, Buccal Cavity, Etc. M 3 — - — - - - - 1 - - 2 F 2 — — — — — — — — — 1 1 Malignant Neoplasm, Oesophagus M 1 — — - — - - - - - - 1 F 4 — — — — — — — — — 4 — Malignant Neoplasm, Stomach M 20 — — — - — — - 3 5 6 6 F 15 - - - - - — - 1 6 8 Malignant Neoplasm, Intestine M 33 — — — — - - 1 1 8 11 12 F 24 - - — — — - — 5 3 5 11 Malignant Neoplasm, Lung, Bronchus M 91 - - - — - - 2 6 34 32 17 F 21 - — - — — — — 3 7 8 3 Malignant Neoplasm, Breast M - — - — - - - - - - - - F 54 - - - - - 1 2 10 21 8 12 Malignant Neoplasm, Uterus F 15 - - - - - - 1 4 4 3 3 Malignant Neoplasm, Prostate M 22 - - - - - - - 3 6 13 Leukaemia M 7 — — 1 - 1 - - - - 4 l F 6 - — 1 1 — - - - 1 — 3 Other Malignant Neoplasms M 44 - - - 1 - 3 1 6 10 8 15 F 76 — — - 1 - - 1 7 14 22 31 Benign and Unspecified Neoplasms M 2 - — — - 1 - 1 - - - - F 3 — - - - - 1 - - 1 l Diabetes Mellitus M 3 — — — — - - - - 1 - 2 F 12 - - - - - - - - 2 5 5 Other Endocrine Etc. M 2 — — 1 1 - - - - - - - Diseases F 9 - - - 1 - - 1 - 3 1 3 Anaemias M 1 — - - 1 - - - - - - - F 1 - - - - - - - - - - 1 Mental Disorders M — — — - - - - - - - - - F 3 - - - - - - - 1 - 1 1 Meningitis M 2 — — - - - - - 1 - 1 - F - - - - - - - - — - - — Other Diseases of Nervous System, Etc. M 11 - 1 - - - - - 1 3 4 2 F 8 - 1 1 - - - 1 - - 3 2 Chronic Rheumatic Heart Disease M 9 — - - - - 1 1 - 2 3 2 F 19 - - - - - - - 4 3 9 3 Hypertensive Disease M 11 - - — — - - - - 1 3 7 F 15 — - - - - - - l 2 3 9 Ischaemic Heart Disease M 282 - - - - - 1 5 26 66 98 86 F 178 - - - - - - 1 8 16 42 11l Other Forms of Heart Diseases M 53 - - - - - - 1 - 4 15 33 F 103 - — - - - - - - 3 10 90 Cerebrovascular Disease M 96 - - - - - - 2 3 10 29 52 F 204 - - - - - - - 1 16 42 145 Other Diseases of Circulatory System M 37 — - - - - - - - 9 15 13 F 44 - - - - - - 2 1 3 9 29 Influenza M 8 — — — - — — - 2 2 3 1 F 5 — — — — — — — — 1 2 2 -24- -25- Causes of death at different periods during: 1969 Causes of Death Sex Total all ages Under 4 weeks 4 Weeks & Under 1 year 1-4 5-14 15-24 25-34 35-44 45=54 55-64 65-74 75 & over Pneumonia M 48 - 1 - - - - 1 1 7 13 25 F 106 4 3 1 - - - 1 3 5 12 77 Bronchitis and Emphysema M 72 - - - - - - 1 - 23 28 20 F 18 - - - - - - - 1 2 5 10 Asthma M l • - - - - - - 1 - - - F 2 - » - - - - - - - 2 - Other Diseases of Respiratory System M 8 - - - - - - - - - 7 1 F 4 - - 1 - - - - - 1 - 2 Peptic Ulcer M 9 - - - - - - - - 2 5 2 F 6 » — - - - - - 1 - 2 3 Intestinal Obstruction and Hernia M 4 - - - - - - - - - - 4 F 3 - - - - - - - - - - 3 Cirrhosis of Liver M 1 - - - - - - - - - 1 - F 2 - - - - - - - 1 1 - - Other Diseases of Digestive System M 7 l - - - - - - - 2 2 2 F 15 - - - - - - 1 - 1 3 10 Nephritis and Nephrosis M 4 - - - - - - - - - 4 - F 3 - - - - - - - - - 2 1 Hyperplasia of Prostate M 6 - - - - - - - - - 1 5 Other Diseases, Genitourinary System M 5 - - - - - - - 1 - 1 3 F 6 - - - - - - - - 1 2 3 Other Complications of Pregnancy, Etc F l - - - - - 1 - - - -- - Diseases of Skin, Subcutaneous Tissue M - - - - - - - - - - - - F 1 - - - - - - - - - - 1 Diseases of Musculoskeletal System M 1 - - - - - - - - - - 1 F — - - - - - - - - - - - Congenital Anomalies M 5 l 2 l 1 - - - - - F 8 3 4 - - - - - - - 1 - Birth Injury, Difficult Labour, Etc. M 6 6 - - - - - - - - - - F 4 4 — - - - - - - - - - Other Causes of Perinatal Mortality M - - - - - - - - - - - - F 6 6 - - - - - - - - - - Symptoms and 111 Defined Conditions M 3 - - - - - - - - - - 3 F 7 - - - - - - - - - - 7 Motor Vehicle Accidents M l6 - - 1 - 4 2 1 3 1 3 l F 11 - - - - 1 - - - 1 4 5 All other Accidents M 11 - 1 - 3 2 - - - 2 1 2 F 15 - 2 1 - - - - 2 1 2 8 Suicide and Self-inflicted Injuries M 11 - - - - 1 - 3 2 3 - 2 F 13 - — — — 1 1 l 1 4 5 - All Other External Causes M l — - - - - 1 - - - - - F - - — - — - - - - - - - TOTAL ALL CAUSES M 971 8 5 5 7 10 8 20 59 201 308 340 F 1,054 17 10 5 3 2 3 13 54 116 226 605 Deaths from all causes: Male Female Total Crude rate per 1,000 Home Population Adjusted rate per 1,000 Population (Comparability factor 1968/69 0.91 1969 971 1054 2025 12.2 11.1 1968 968 1074 2042 12.3 11.2 1967 965 1025 1990 12.04 11.52 Deaths from certain causes Category 1950 1960 1965 1966 1967 1968 1969 Tuberculosis, respiratory 39 9 8 7 9 5 4 Cancer, Uterus 11 17 15 18 15 11 15 Cancer, Bronchus, Lung 52 83 119 121 120 113 112 Coronary disease 291 362 379 374 400 523 460 Bronchitis 75 82 88 94 83 93 90 Suicide 15 19 14 13 15 20 24 Motor vehicle accidents 13 18 23 22 23 18 27 All other accidents 26 17 22 18 26 23 26 -26- Suicide Suicide Rate per 1,000 deaths Total as % of total deaths Rate per 1,000 population Male Female Total Male Female Total 1969 11.32 12.33 11.85 1.13 1.23 1.19 0.14 1968 13.42 6.51 9.79 1.34 0.65 0.98 0.12 1967 8.29 6.83 7.54 0.83 0.68 0.75 0.09 Twenty and twenty four persons in the Borough ended their own lives during 1968 and 1969,respectively. A number of surveys have been carried out to determine the frequency of attempted suicide compared to that which is successful. The 1964 report of the Chief Medical Officer of the Ministry of Health records figures varying from 10 and 6: 1. Applying this range of figures to the Sutton cases, between 260 and 440 people may have attempted to terminate their own lives during the years 1968 and 1969. Infant Deaths MALES FEMALES Age Legit. Illegit. Total Legit. Illegit. Total TOTAL Under 1 year of age 1969 13 - 13 23 4 27 40 1968 25 - 25 8 1 9 34 1967 18 1 19 16 4 20 39 Under 4 weeks of age 1969 8 - 8 13 4 17 25 1968 20 - 20 6 1 7 27 1967 16 1 17 10 2 12 29 Under 1 week of age 1969 6 - 6 8 4 12 18 1968 20 - 20 6 - 6 26 1967 14 1 15 8 2 10 25 -27- Infant Mortality Rates 1969 1968 1967 Infant Total Infant deaths per 1,000 total live births 17.2 14.8 15.84 Legitimate infant deaths per 1,000 legitimate live births l6.4 15.4 14.70 Illegitimate infant deaths per 1,000 illegitimate live births 29.4 6.09 33.34 Neo-natal Deaths under four weeks per 1,000 total live births 11.0 11.08 11.78 Early Neo-natal Deaths under one week per 1,000 live and stillbirths 8.O 10.0 10.04 Peri-natal Stillbirths and deaths under one week combined per 1,000 total live and stillbirths 14.0 24.0 20.88 Maternal Number of deaths 1.0 1.0 NIL Rate per 1,000 total live and stillbirths 0.23 0.23 NIL -28- Births 1st January - 31st December, 1967 LIVE STILL Legit Illegit Total Legit Illegit Total M 1229 M 65 M 129 M 12 M - M 12 F 1084 F 85 F 1169 F 12 F 3 F 15 2313 150 2463 24 3 27 93.9% 6.1% 100% 89.9% 11.1% 100% Total live and still births 2490 Live Birth Rate per 1,000 Home Population Number of Still Births Males 12 Crude Adjusted by Comparability Factor 1.03 Females 15 TOTAL 27 Still birth rate per 1,000 live and still births 10.84 14.9 15.36 1st January - 31st December, 1968 LIVE STILL Legit Illegit Total Legit Illegit Total M 1122 M 76 M 1198 M 12 M - M 12 F 1014 F 88 F 1102 F 15 F 3 F 18 2136 164 2300 27 3 30 92.87% 7.13% 100% 90% 10% 100% Total live and still births 2330 Live Birth Rate per 1,000 Home Population Number of Still Births Males 12 Females l8 Crude Adjusted by Comparability Factor 1.03 TOTAL 30 Still birth rate per 1,000 live and still births 13.0 13.9 14.27 -29- Births 1st January - 31st December, 1969 LIVE STILL Legit Illegit Total Legit Illegit Total M 1145 M 61 M 1206 M 6 M — M 6 F 1042 F 75 F 1117 F 7 F 1 F 8 2187 136 2323 13 1 14 93.78% 6.22% 100% 92.4% 7.6% 100% Total live and still births 2337 Live: Birth Rate per 1,000 Home Population Number of Still Births Males 6 Females 8 Crude Adjusted by Comparability Factor 1.03 TOTAL 14 14.0 14.4 Still birth rate per 1,000 live and still births 6.0 -30- Vital Statistics - Greater London 1969 L.B. Sutton Greater London Inner London Outer London Live births, crude rate per 1,000 population 14.0 15.7 15.7 15.7 Illegitimate live births, per cent of total 6.22% 11.0 15.4 8.3 Still births per 1,000 live and still births 6.0 12.7 13.4* 12.3* All deaths, crude rate per 1,000 population 12.2 11.5 11.9 11.2 Infant mortality, per 1,000 live births Under 1 year 17.0 17.9 20.4* 16.2 Neo-natal 11.0 11.7 13.3* 10.8* Early Neo-natal 8.0 10.2 11.7* 9.2* Perinatal (per 1,000 live and still births) 14.0 22.8 25.0 21.4 Maternal mortality, per 1,000 live & still births (excluding deaths due to abortion) 0.23 0.20** 0.21** 0.19** * Figure based upon less than 1,000 occurrences ** Figure based upon less than 100 occurrences. The area comparability factors for Greater London are: Births 0.93 Deaths 1.01 The area comparability factors for L.B. of Sutton are: Births 1.03 Deaths 0.91 -31- epidemiology part ii INDEX Page No. PREVALENCE AND CONTROL OF INFECTIOUS DISEASE 33 IMMUNISATION AND VACCINATION 35 VENEREAL DISEASES 37 MASS RADIOGRAPHY 37 IMMIGRATION 38 P WESTCOMBE MB BS DPH Medical Officer of Health -32- - 33 - Infectious Diseases Notified During The Period 1st January to 31st December. 1968. DISEASES Under 5 5-14 15 - 44 45 - 64 65 or over age unknown TOTAL M F M F H F M F M F M F M F DIPHTHERIA -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) DYSENTERY 8(4) 4(2) 1(7) -(11) -(2) 1(4) -(-) -(-) -(-) -(-) -(-) 1(1) 9(13) 6(18) ENCEPHALITIS -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) ERYSIPELAS -(-) -(-) -(-) -(-) -(1) -(2) -(-) -(1) -(-) -(1) -(-) -(-) -(1) -(4) FOOD POISONING 1(9) 4(5) 1(1) -(1) 1(4) 2(4) -(-) -(-) -(-) -(-) -(-) -(1) 3(14) 6(11) MALARIA -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) l(-) -(-) l(-) -(-) MEASLES 87(697) 98(623) 70(405) 77(388) 2(7) -(11) -(-) -(-) -(-) -(-) 5(1) 3(2) 164 (1110) 178(1024) MENINGOCOCCAL MENINGITIS -(-) -(-) -(1) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(l) -(-) OPHTHALMIA NEONATORUM -(-) -(l) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(1) PARATYPHOID -(-) -(-) -(-) -(-) -(-) -(1) -(-) -(-) -(-) -(-) l(-) -(-) l(-) -(1) POLIOMYELITIS -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) SCARLET FEVER 11(16) 7(17) 30(32) 21(31) -(1 ) 5(1) -(-) -(-) -(-) -(-) -(1) -(-) 41(50) 33(49) SMALLPOX -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) TYPHOID -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) -(-) TUBERCULOSIS (Pulmonary) -(-) -(-) -(2) -(-) 2(5) 3(4) 2(3) 4(-) 4(5) 2(2) -(-) -(1) 8(15) 9(7) TUBERCULOSIS (Non Pulmonary) l(-) -(-) -(-) -(-) -(-) -(-) l(-) -(-) -(1) -(-) -(-) -(-) 2(1) -(-) WHOOPING COUGH 11(20) 11(21) 5(14) 11(11) -(-) -(-) -(-) -(-) -(-) -(-) -(1) -(-) 16(35) 22(32) -34- Infectious Diseases Notified During The Period 1st January to 31st December, 1969. DISEASE Under 5 5-14 15 - 44 45- 64 65 or over age unknown TOTAL M F M F M F M F M F M F M F diphtheria - - - - - - - - — - - - - - DYSENTERY 2 3 5 2 3 5 - - - - 1 - 11 10 ENCEPHALITIS - - 1 - 2 - - - - - - - 3 - FOOD POISONING - - - - 2 1 - - - 1 - - 2 2 INFECTIVE JAUNDICE 1 - l 1 6 5 - 1 - - - 1 8 8 MALARIA - - - - - - - - - - - - - - MEASLES 101 103 87 66 1 3 - - - - 6 2 195 174 MENINGOCOCCAL MENINGITIS - - - - - - - - - - - - - - OPHTHALMIA NEONATORUM - - - - - - - - - - - - - - PARATYPHOID - - - - - - - - - - - • - - - POLIOMYELITIS - - - - - - - - - - - - - - SCARLET FEVER 10 10 35 28 1 - - - - - - 1 46 39 SMALLPOX - - - - - - - - - - - - - - typhoid - - - - - l 1 - - - - - l 1 TUBERCULOSIS (Pulmonary) - - - 2 4 4 2 2 4 1 - 9 10 TUBERCULOSIS (Non Pulmonary) - - - 1 1 - - 1 - 2 - - 1 4 WHOOPING COUGH 6 9 4 - - - - - - - - - 10 9 Infectious Diseases. The introduction, early in 1968 of vaccination against measles as a matter of public policy was an important addition to the routine programme of immunisation against the infectious diseases. The winter of 1969 would normally have seen a widespread epidemic, conforming to the bi-annual pattern of incidence of this disease. The number of cases notified (369) however was very much the same as in the previous year, (342) contrasting with 2134 cases in 1967, probably because of the impact of measles vaccination in the susceptible child population. The initial enthusiasm for vaccination by the general public waned somewhat during 1969, resulting in fewer children being protected than is desirable. It is very important indeed that the whole child population should be protected as quickly as possible if the full potential of the vaccination programme is to be achieved, and measles is to be eradicated. This is a disease which has come to be accepted as one of the inevitable childhood ailments and is treated lightly by most parents. In most cases the illness, though unpleasant, is soon over. In a proportion however, complications occur which may result in permanent disability. Both complicated and uncomplicated, measles make heavy demands on scarce health service resources; from personal health and national points of view therefore, vaccination against the disease is important and parents are asked to see that their children are protected. The following: table shows the percentages immunised bv 31.12.1969. Children Born in 1967. Children Born in 1968. Whooping cough Diphtheria Poliomyelitis Whooping cough Diphtheria Poliomyelitis Smallpox (Children under 2). 95 95 95 74 76 79 46 Figures in respect of children born in 1968 are low due to the revised schedule of immunisation under which many children had not completed their immunisation. -35- Immunisation and Vaccination - 1st January - 31st December, 1968 & 1969. Type of Protection Completed Primary Courses Received Reinforcing doses (Booster). 1968 1969 1968 1969 Diphtheria/Pertussis/Tetanus 2249 1148 1979 1803 Diphtheria/Tetanus 130 89 3012 3003 Diphtheria 4 15 118 114 Tetanus 491 239 363 332 Poliomyelitis Salk vaccine 2 - - - Sabin (Oral vaccine) 2714 1584 4510 5406 Smallpox 1892 1635 163 145 Measles 3426 1405 - - Protection against smallpox, diphtheria, whooping cough, tetanus and poliomyelitis cases is available at all the Council's clinics and at the surgeries of all general practitioners. All mothers of young children are notified by health visitors of the need for immunisation and are constantly reminded by widely displayed posters and leaflets. Vaccination against tuberculosis is offered to all contacts of infectious cases and carried out by the chest physician, In addition all school children who have not acquired natural immunity are offered this protection at approximately thirteen years of age. Pupils who may have acquired natural immunity are referred to the chest physician for chest x-ray to ensure that no treatment is necessary following their exposure to the infection. There is a welcome increase in the percentage of children under two years of age who had by the end of the year completed immunisation against whooping cough, diphtheria and poliomyelitis. There is also a very considerable increase in the number of children who were immunised against tetanus. With the ever-increasing availability of travel abroad constant vigilance by General Practitioners, Hospitals and Public Health Authorities is necessary to prevent the undetected importation of infection by holiday makers and others who may arrive in this country before symptoms become obvious. Persons travelling abroad are strongly advised to take note of the advice given in the "Notice to Travellers" issued by the Department of Health and Social Security to ascertain what additional protection is advised and to obtain the appropriate inoculations before travelling abroad. -36- VENEREAL DISEASE. In my report for 1967 attention was drawn to the nationally increased numbers of venereal disease notifications which at that time were not dramatically significant locally. Notifications from Treatment Centres applicable to Sutton, of new cases during the last three years are as follows:- 1967 1968 1969 SYPHILIS 3 7 5 GONORRHOEA 41 44 56 OTHER VENEREAL CONDITIONS 309 304 439 TOTAL 353 355 500 Venereal disease statistics are notoriously difficult to interpret precisely because they relate to a number of clinical conditions and patients suffering from these diseases may attend a number of treatment centres whose criteria for notification may vary. The statistics above may well include a number of new attendances for which no treatment was found to be necessary. There can however, be little doubt that a real increase in the incidence is taking place. It is not without significance that in 1969 the number of cases notified exceeds that of measles notifications making Venereal Disease the commonest notifiable infectious disease for the year. MASS RADIOGRAPHY. The number of persons x-rayed by the Mass Radiography Unit during its visit to sites in the Borough varies greatly from year to year. I am indebted to the Director of the Unit for the following statistics:- 1966 1967 1968 1969 Total x-rayed (5,420) 11,888 2,822 11,006 Males (2,380) 5,803 1,351 Not available No breakdown Females (3,040) 6,085 1,471 this year. 1968 Male 1968 Female 1969 Male 1969 Female Cases of Lung Cancer 1 1 4 1 Cases of Pulmonary T.B. 1 Nil Nil 1 All health screening procedures are open to the criticism that findings relate only to the day upon which screening takes place and carry no guarantee that the future is secure. The number of defects discovered during the period under review is low and the cost relatively high. Nevertheless, mass x-ray when reviewed as part of general health screening activities is a valuable procedure. Efforts to make the techniques more productive if positive findings should be directed towards encouraging those age groups most at risk to make use of the service and this will be done when more of the department's resources can be deployed on well-person screening. -37- IMMIGRATION Under the Commonwealth Immigration Act, 1962, long stay immigrants are required to supply immigration officers with their destination address. This is forwarded to the Medical Officer of Health of the appropriate area and a visit is paid by a member of his staff. This is a useful procedure which enables contact to be made with the newly arrived immigrant at an early stage. Health aspects of immigration are two-fold. The immigrant may be suffering from ill health which requires treatment and action to prevent the possible spread of infection or he may be exposed to infection in this country against which he has little or no immunity. Many immigrants to the Borough are employed in local hospitals. Those who are not are advised by the health visitors of the facilities available under the National Health Service and encouraged to register with a general practitioner. Where there are families appropriate arrangements are made for their protection against infectious disease and the mothers and children receive the normal health supervision available to the community as a whole. Country where passport was issued as stated by Port Health Authority. Number of advice notes received during 1968 and 1969 from ports and airports relating to the arrival of immigrants Number of first successful visits paid during 1968 and 1969 Number of Pulmonary Tuberculosis notifications received in respect of immigrants during 1968 & 1969 (A) 1968 1369 1968 1969 1968 1969 Commonwealth Countries. 1. Carril|ean 10 12 4 1 - - 2. India 10 10 4 2 - - 3. Pakistan 3 5 1 4 - - 4. Other Asian 7 10 2 6 - - 5. African 5 7 1 1 - - 6. Other 10 10 4 7 - - (b) Non Commonwealth 1. European 36 45 22 14 - - 2. Other 12 12 4 4 - - total 93 111 42 39 - In addition Medical Superintendents at Hospitals followed-up 36 immigrants joining hospital staffs in 1968 and 37 in 1969. -38- HEALTH SERVICES DIVISION PART III Personal and School Health Services INDEX MATERNAL AND CHILD WELFARE 40 THE OBSERVATION AND HANDICAP REGISTER 44 THE WORK OF CHILD WELFARE CENTRES 49 DISTRIBUTION OF WELFARE FOODS 51 THE WORK OF HEALTH VISITORS AND SCHOOL NURSES 51 DOMICILIARY MIDWIFERY AND HOME NURSES 55 DAY NURSERY SERVICE 59 CARE OF THE UNMARRIED MOTHER AND HER CHILD 59 RECUPERATIVE HOLIDAYS 60 DENTAL CARE OF MOTHERS AND YOUNG CHILDREN 60 HOME HELP SERVICE 63 CERVICAL CYTOLOGY 63 CHIROPODY SERVICES 64 THE CARE OF THE MENTALLY HANDICAPPED 65 SUBNORMALITY 65 MEDICO-SOCIAL WORK 67 HEALTH EDUCATION 67 HOME SAFETY 68 NURSING HOMES 69 NURSES' AGENCIES ACT, 1957 69 NURSERIES AND CHILD MINDERS REGULATION ACT, 1948 69 MEDICAL ARRANGEMENTS FOR CHILDREN'S HOMES AND RESIDENTIAL NURSERIES 70 STAFF MEDICAL EXAMINATIONS 71 SELECTIVE MEDICAL EXAMINATIONS 72 FINDINGS AT MEDICAL INSPECTION 73 MEDICAL TREATMENT 77 SCHOOL DENTAL SERVICE 78 SPECIAL SERVICES 8l AUDIOLOGY 81 SPEECH THERAPY 8l CHILD GUIDANCE SERVICE 8l INFECTIOUS DISEASE 84 IMMUNISATION AND VACCINATION 84 HANDICAPPED PUPILS AND SPECIAL SCHOOLS 85 EMPLOYMENT OF CHILDREN OF SCHOOL AGE 89 PHYSICAL EDUCATION IN SCHOOLS 89 PROVISION OF MEALS AND MILK 90 W H Kinstrie MB Ch B DPH Chief Medical Officer and Principal School Medical Officer -39- Personal Health Services Local Health Authority Personal Health Services are provided under the various sections of Part III of the National Health Service Act 1946. They are complementary to the services provided by the Regional Hospital Boards (hospitals and specialists) and Executive Councils (general medical practitioners, general dental surgeons, opticians and pharmacists) and with the exception of the ambulance service (Greater London Council) are the responsibility of the Borough Council,. They provide health services for all age groups and sections of the population, particular emphasis being laid on the most vulnerable members of the community, the very young, expectant and nursing mothers, the elderly and the handicapped,, They do not provide medical treatment except in a few minor instances but are concerned with the maintenance of normal mental and physical health and the early detection of abnormality. This work has many aspects and the account of work carried out during the two years 1968/69 which follows, reports the major activities of the medical, and nursing staff of the Health Division,, MATERNAL AND CHILD WELFARE Births 1st January, 1968, to 31st December, 1969. (a) In the area including those normally resident elsewhere (b) Resident in the area including those born elsewhere, i.e. (a) adjusted by inward and outward transfers 1969 1968 1967 1969 1968 1967 Live 3022 3258 3266 2380 2404 2515 Still 19 36 41 13 28 26 Total 3041 3294 3307 2393 2^32 2^1 Births; in hospital 2127 2039 2089 at home 266 393 452 -40- -41- PREMATURITY The following table gives details of premature births and stillbirths notified in the London Borough of Sutton during the period 1st January 1968 - 31st December 1968 as adjusted by transferred notifications: (1967 figures in brackets) PREMATURE LIVE BIRTHS PREMATURE STILL- BIRTH Weight at Born in Hospital Born at home or in a Nursing Home Transferred to Hospital on or before the 28th day. Born at home or in a Nursing Home Born in Hospital DIED DIED T o T A L Within 24 hrs of birth Between 1 and 7 days Between 7 and 28 days T o T A L Within 24 hrs of birth Between 1 and 7 days Between 7 and 28 days T o T A L Within 24 hrs of birth Between 1 and 7 days Between 7 and 28 days 21b.3ozs. or less 3 1 - - - - - - - - - - - 2 (5) (3) (-) (1) (-) (-) (-) (-) (-) (-) (-) (-) (1) (-) over 21b.3ozs 14 3 3 - - - - - - - - - - 1 (12) (-) (6) (-) (-) (-) (-) (-) (-) (-) (-) (-) (2) (3) up to & inc 31b.4ozs. over 31b.4ozs. 17 5 - - 1 - - - - - - - - 9 (25) (4) (l) (-) (-) (-) (-) (-) (-) (-) (-) (-) (-) (4) up to & inc 41b.6ozs. over 4lb.6ozs. 37 3 1 - - - - - - - - - - 1 (29) (2) (1) (-) (-) (-) (-) (-) (1) (1) (-) (-) (-) (1) up to 8c inc 4lb.l5ozs. over 41b. 15ozs. 73 3 l - - - - - - - - - - - (60) (-) (-) (-) (2) (-) (-) (-) (1) (-) (-) (-) (-) (1) up to 8c inc 51b.8ozs. TOTAL 144 15 5 - 1 - - - - - - - - 13 (131) (9) (8) (1) (2) (-) (-) (-) (2) (1) (-) (-) (3) (9) -42- PREMATURITY The following table gives details of premature births and stillbirths notified in the London Borough of Sutton during the period 1st January 1969 ~ 31st December 1969 as adjusted by transferred notifications5 (1968 figures in brackets). Weight at Birth PREMATURE LIVE BIRTHS PREMATURE STILLBIRTHS Born in Hospital Born at home or in a Nursing Home Trransferred to Hospital on or before the 28th dav Born at home or in a Nursing Home Born in Hosp. DIED DIED T o T A L Within 2k hrs. of birth Between 1 and 7 days Between 7 and 28 days T o T A L Wi thin 2k hrs of birth Between 1 and 7 days Between 7 and 28 days T o T A L Within 2k hrs. of birth Between 1 and 7 days Between 7 and 28 days 2 lb„3ozs. 3 2 1 - - - - - - - - - - 2 or less (3) (1) (-) (-) (-) (-) (-) (-) (-) (-) (-) (-) (-) (2) over 2 lb.3ozs. 6 2 - - - - - - - - - - - 4 up to & inc. 3 lb.4ozs. (14 (3) (3) (-) (-) (-) (-) (-) (-) (-) (-) (-) (-) (1) over 3 lb.4ozs. 18 2 l 1 1 - - - 1 - - 1 - 1 up to & inc. 4 lb.6ozs. (17) (5) (-) (-) (1) (-) (-) (-) (-) (-) (-) (-) (-) (9) over 4 lb. 60 zs. 20 - 2 - - - - - - - - - - - up to & inc. 4 lb.15 ozs. (37) (3) (1) (-) (-) (-) (-) (-) (-) (-) (-) (-) (-) (i) over 4 lb.15 ozs. 48 - 2 - 1 - - - - - - - - 1 up to & inc. 5 lb.8 ozs. (73) (3) (1) (-) (-) (-) (-) (-) (-) (-) (-) (-) (-) (-) TOTAL 95 6 6 1 2 - - - 1 - - 1 - 8 (144) (15) (5) (-) (1) (-) (-) (-) (-) (-) (-) (-) (-) (l3) These tables emphasise the serious loss of infant lives associated with prematurity and during the first month of life. The size of the problem can most simply be shown as follows Total Non Premature Premature* 1969 1968 (1967) 1969 1968 (1967) 1969 1968 (1967) Live births 2380 2404 (2515) 2284 2261 (2380) 96 143 (135) Deaths among live births in the first month of life 26 27 (29) 10 8 (10) 16 19 (19) Still births 13 28 (26) 5 12 (14 8 16 (12) * The Department of Health and Social Security's definition of a premature birth is one when the infant at birth weights 5½ lb. or less. CONGENITAL ABNORMALITIES It is a responsibility of the Medical Officer of Health to submit a confidential report to the Registrar General on congenital abnormalities detected at or shortly after birth. The following table shows the total notified to the Registrar General:- ] 1967 1968 1969 Total children born with abnormalities 85 47 67 Number of those who were stillborn 1 9 2 Number of those born alive who died within ten days 7 2 Nil Number born with serious defects 25 21 11 Number which were of a comparatively minor nature 60 26 56 -43- THE OBSERVATION AND HANDICAP REGISTER In recent years it has been increasingly recognised that many of the children who need special educational consideration in school and support later in life acquire their handicapping conditions in the pre-natal, neo-natal or early post-natal periods of life.. Infants who have been exposed to unfavourable heredity or adverse experiences during this period are considered to be "At Risk" and a register is kept of these cases so that they can be offered medical examination at regular intervals until it is certain that their development is normal,, In addition the growing child may be placed at risk by accident or illness occurring during childhood,, In order to ensure that each handicapped child, even if suffering from only a minor defect, is assisted to the extent necessary to make full use of ability a register known as the "Observation and Handicap Register" is compiled. Children whose names appear on this register are kept under special surveillance until 5 years of age by medical examination and assessment of their developmental progress. Social circumstances are also taken into account as home conditions and attitudes, together with family relationships, may make a significant contribution to progress. Close co-ordination of the work of various agencies who are concerned with the well-being of the handicapped child is essential and this involves close contact with general practitioners, hospitals and voluntary organisations, the "Observation and Handicap Register" provides the means by which this is achieved and, where necessary, ensures the future provision of educational facilities suited to the child's ability. From this diagram it can be seen how the register is compiled. -44- THE OBSERVATION AND HANDICAP REGISTER Table I Number of cases on Register As at Year of Birth TOTAL 1964 1965 1966 1967 1968 1969 31.12.69 - 73 15k 169 173 153 722 31.12.68 35 94 114 120 110 - 473 31.12.67 87 98 140 149 - - 576 Table 2 Number of cases with severe or multiple handicaps As at YEAR OR BIRTH TOTAL 1964 1965 1966 1967 1968 1969 Number of severely Handicapped children 31.12.69 1 6 2 2 - 11 31.12.68 3 3 3 2 1 - 13 31.12.67 7 3 8 10 - - 32 Number of children with multiple defects 31.12.69 - 5 12 10 2 1 30 31.12.68 8 7 8 9 1 - 33 31.12.67 17 10 7 16 - - 63 -45- TABLE 5 The Handicapped Pre-School Child This table shows the number of children with each type of defect born in each of the last five years, but as some children have more than one defect the sum total of defects is not the same as the total number of cases on the Register. The figures given in this table include the cases shown in Table 2. Handicap or Defect YEAR OF BIRTH TOTAL 1965 1966 1967 1968 1969 DEFECTS OF EAR OR FACE including: absence of pinna or meatus, accessory auricle, bat ear, naevae, skin tags, micrognathia 1 3 1 2 7 DEFECTS OF MOUTH including: hare lip, cleft palate 1 2 4 3 10 DEFECTS OF ALIMENTARY SYSTEM including: pyloric stenosis, oesophagael atresia, jejunal atresia, imperforate anus, defects of liver, hernia, Hirschsprung's disease 1 6 10 13 9 39 Osteogenesis Imperfecta 1 1 2 SKELETAL DEFORMITIES including: achondroplasia, chondrodystrophy, dwarfism, arachnodactyly, reduction deformities, Pierre Robin Syndrome 3 2 9 SYNDACTYLY, POLYDACTYLY 2 2 1 1 6 TALIPES, AND OTHER FOOT DEFORMITIES 3 6 18 6 10 43 CONGENITAL DISLOCATION OF HIP 2 4 5 4 7 22 DEFECTS OF UROGENITAL SYSTEM including: Hypospadias, epispadias, undescended testicles, hydrocele, defects of female genitalia, defects of kidney, ureters, etc. pseudo-hermaphrodism 1 6 10 2 7 26 MUSCULAR DEFECTS including: spastic, absence of muscles, arthogryphosis, torticollis, hemiplegia 1 3 3 2 1 10 OTHER MINOR PHYSICAL DEFORMITIES including: pilonidal sinus 1 1 3 1 6 -46-  YEAR OF BIRTH Handicap or Defect 1965 19b6 1967 1968 1969 TOTAL BLINDNESS 1 1 2 MICROPHTHALMOS, BUPHTHALMOS 1 1 SQUINT 2 10 5 2 2 21 NYSTAGMUS 1 1 SEVERE VISION DEFECT, CATERACT 2 2 2 6 DEAFNESS 1 l PARTIAL HEARING, or HEARING DEFECTS 4 6 2 4 2 18 SPEECH DEFECTS 7 13 3 23 DISEASES AND DEFECTS OF RESPIRATORY SYSTEM includings Hyaline membrane disease, asthma, chronic bronchitis 3 5 3 9 3 23 BLOOD DISORDERS, including: Christmas Disease 3 1 4 5 6 19 SKIN DISORDERS, including; Ichthyosis congenita, eczema, large naevae l 4 5 5 2 17 METABOLIC DISORDERS including: Fibrocystic disease 1 1 1 1 4 PHENYLKETONURIA CARDIAC DEFECTS 8 11 16 9 2 46 OTHERS NEEDING OBSERVATION for suspected physical defect 25 63 65 88 91 332 MENTAL RETARDATION 2 3 1 1 7 MICROCEPHALY 1 1 EPILEPSY, OR SEVERE CONVULSIONS 1 2 2 1 6 MONGOLISM 1 2 3 4 1 11 SPINA BIFIDA, HYDROCEPHALUS 3 2 7 5 4 21 OTHERS NEEDING OBSERVATION FOR MENTAL RETARDATION AND OTHER C.N.S. LESIONS 5 7 4 1 17 Total number of children "At Risk" at end of 1969 1740 Total number of children "At Risk" at. end of 1968 2290 -47- DETAILS OF CLINICS The purpose-built clinics in the Borough sire as follows:- Alexandra Gardens Green Wrythe Lane Priory Crescent Ridge Road *Robin Hood Lane Health Centre Rochester Road øRoundshaw Shotfield +The Mount *Robin Hood Lane comprehensive Health Centre was opened in September 1969 and in addition to the usual Local Authority clinic facilities, 8 general practitioners have their surgeries in the Centre. The Child Guidance Clinic previously at 25 Worcester Road, Sutton, is also incorporated in the Centre. Although there have been minor teething problems in connection with the new Centre, the general practitioners, as well as the Local Authority staff, are delighted with the facilities available. The Close proximity of general practitioners with Local Authority staffs, particularly health visitors, district nurses and midwives, has considerably improved the liaison between these different branches of the Health Service to the benefit of the families in central Sutton. øRoundshaw. A temporary clinic created by adaptation of two flats, was opened at Roundshaw in February 1969. These clinic premises were offered to the Executive Council for the use of a general practitioner appointed by the Executive Council for the Roundshaw Estate and the general practitioner commenced practise on 1st October, 1969. +The Mount Clinic, on Clockhouse Farm Estate was under-used by the Local Authority. A general practitioner made application for use of part of the Clinic for his surgery and commenced practice in July 1969. In addition to the purpose-built clinics, a limited number of sessions are held in the following premises All Saint's Church Hall, New Road. The Church Hall, Ruskin Drive Methodist Church Hall, Station Road, Belmont. Parochial Hall, Cheam. Scouts Hall, Guy Road, Beddington. -48- THE WORK OF CHILD WELFARE CENTRES The work of child welfare centres consists of supervision of the development of normal young children and those ascertained as "at risk", early detection of abnormalities of development; provision of facilities for immunisation and vaccination against infectious disease; giving advice concerning the feeding and management of children and the measures necessary for the promotion of family health. The nature and content of this work has changed very considerably since its inception. The emphasis is now directed away from the detection and treatment of the gross defects found in former years towards the more subtle problems of developmental abnormality and family relationships. Advice concerning behaviour problems now forms a very considerable part of the work carried out by medical officers and health visitors in their consultation clinics, work demanding very different skills to those formerly necessary. Special toddlers clinics have been held in all the main clinics where children are seen by appointment annually for assessment of their physical and mental development and where more time can be devoted to mothers who have problems than is possible at the general clinic sessions. Special sessions are arranged for immunisation and vaccination of children where the numbers attending justify separation from general infant welfare sessions. -49- -50- Child Welfare Centres Number of children who attended during period 1st January 1968 to 31st December 1969 YEAR 1st Attendances of Children Born in: No. of Sessions held by No. of Children referred elsewhere for consultant advice No. of Children on "At Risk" register at end of year 1969 1968 1964/67 1963/66 1962/65 TOTAL Total Attendances Asste Medical Officers G.P's employed on sessional basis Total No, of Sessions 1969 2589 2494 5272 - - 10355 40055 1192 126 1318 40 1740 1968 2184 2275 - 5140 - 9599 50056 1086 135 1295 65 2290 1967 2327 1973 - - 4208 8508 52703 1107 143 1250 114 2909 DISTRIBUTION OF WELFARE FOODS 1. Government Scheme The Council acts as agent for the distribution of National Dried Milk, Cod Liver Oil, Orange Juice and Vitamin A and D tablets to authorised beneficiaries, The major part of the work is handled on behalf of the Council by members of the W.R.V.S. and other voluntaryworkers whilst the detailed accounting for the scheme is dealt with by the Medical Officer of Health and the Borough Treasurer, The help given by the W.R.V.S. in this scheme is greatly appreciated. Issues 1st January 1968 to 31st December 1969 Year National Dried Milk (tins) Cod Liver Oil (bottles) Orange Juice (bottles) A & D Tablets (packets) 1969 11852 1871 53665 3225 1968 14750 1808 42986 2809 1967 16450 2012 42709 3276 2. Proprietary Welfare Foods It is customary for infant welfare clinics to hold a stock of proprietary brands of welfare foods approved by the Medical Officer of Health for sale to bona fide clinic attenders at reduced prices, In most clinics this work is the responsibility of voluntary committees working in close co-operation with the professional staff. The profits made by these voluntary bodies are used to further the work of the clinics. The help given by voluntary workers at clinics, not only in the sale of proprietary welfare foods, but in assisting the Health Visitors, is greatly appreciated, THE WORK OF HEALTH VISITORS AND SCHOOL NURSES HEALTH VISITING Care of Mothers and Young Children Health Visitors carry out a programme of home visits, screening tests, consultations at clinics and group discussions with parents until the child reaches the age of five years. The following tables show the extent of their work. - 51 - 1. Clinic Sessions 1969 1968 1967 Ante-Natal and Post-Natal 337 158 182 Infant Welfare and Toddlers examination 1318 1295 1250 Mother craft 301 303 328 Parent craft 120 85 38 Health Education 42 48 54 Hearing Tests 220 228 232 2. Health Visitors case load for children aged 0-5 years 0-1 yr. 1-5 yrs. 0-5 yrs. Families 1969 1968 1967 1969 1968 1967 1969 1968 1967 1969 1968 1967 Total 2218 2665 2354 9818 9116 8936 12036 11781 11290 9273 8443 8312 Average case load for staff in post (1969 - 25 1968 - 23 1967 - 22) 88 116 107 393 398 406 48l 512 513 371 367 378 The ratio of Health Visitors to population, as advised by a Ministry of Health working party reporting in 1961 is 1 to 4,300. Our ratio for 1969 was 1-6,300 and for 1968 was 1-7,009. 3. Home Visits 1969 1968 1967 Children 0-5 12320 11793 11095 Persons over 65 740 772 929 The Chest Clinic Health Visitor, who is mainly employed at the Chest Clinic consultation sessions, carried out the following number of visits in connection with the control of Tuberculosis: 508(1969), 560(1968), 659(1967). - 52 - Screening Procedures Research continues in the Borough with continuous surveys of children born with spina bifida and other congenital malformations. There are screening procedures offered to the parents of all infants: a) Phenylketonuria test at 3 weeks of age (to be replaced by the Guthrie test at 6 days of age on 1st January 1970.) b) Cystic Fibrosis at 3-4 months of age in conjunction with the Medical Superintendent of Queen Mary's Hospital for Children. c) Hearing test at 8 months. As a result of these screening tests a small number of children are found to have abnormalities before symptoms are apparent and appropriate treatment is arranged very early in life, thereby minimising the severity of the defect. Audiology Clinic Children failing hearing tests can be referred for more detailed examinations at the Audiology Clinic. The numbers so referred are as follows: Age New Cases Total Consultations Ref. ENT Dept. Ref. Partially Hearing Unit 1969 0-2 27 35 2 - 2-5 75 86 14 - 1968 0-2 18 21 - - 2-5 67 76 11 1 The Mothers' Clubs These clubs are held every week or fortnight at the local Health Authority clinics for all mothers with children under 5 years of age. Clubs are organised either during the day, when there is a rota for the mothers to care for the children in another room, or in the evening. Health Visitors initially make arrangements to form a club at their clinics and subsequently hand over responsibility for the actual running of the club to the mothers, but are always available for advice and guidance. The London Borough of Sutton require no payment for the use of the premises where clubs are held, provided 50% of the time is spent in Health Education. Various speakers are invited to address the mothers on varied and topical subjects, including medical, homemaking and intellectual matters. Many of the Mothers Clubs are very enterprising and the young mothers make friends outside the home and enjoy social activities coupled with stimulating educational topics. They are a "morale booster" to many a young mother moving into a new area or giving up work when the first baby arrives. - 53 - Care of the Elderly and Handicapped The geriatric health visitor continues to act as a liaison officer between the Geriatric Unit at St. Helier, Sutton General and Wandle Valley Hospitals and the health visitors in the field. Special emphasis is placed on prevention of breakdown of families who care for the elderly and handicapped. Every effort is made to give support to the relatives. Advisory Clinics for the Elderly These clinics are held for the continued surveillance of health in both men and women on reaching pensionable age, and to stimulate an intellectual interest in life and provide companionship. Sessions are held at the Local Health Authority clinics staffed by Health Visitors and Clinic Nurses. A health assessment is made usually at the first visit. Vision, hearing and urine tests are carried out, blood pressure checked and haemoglobin measured. If any abnormality is detected the general practitioner is notified immediately. At the first visit therapeutic listening by the Health Visitor plays an important part in the success of these clinics. The 6-8 sessions include much use of visual aids and talks are given by the Health Visitor and specialist speakers on many aspects of personal health and a variety of other subjects;- nutrition, the prevention of accidents, hobbies, etc. The number in each group is approximately 20 - 25 and they often break up into smaller groups of b for 10 - 15 minutes discussion and then relate their findings to the whole group. This enables all members to participate and proves a stimulating experience for the group. There is a break for refreshments when members have an informal chat amongst themselves and this is followed by a period of simple exercises to music. These sessions are informal and relaxed and the Health Visitors encourage their clients to attend Old People's Welfare Clubs, Luncheon Clubs etc. The Advisory Clinics have proved to be very popular and there is often a reluctance on the part of those attending to leave. Staff Two student health visitors began training in September 196? and qualified in September 19b8. Both students trained at the Ewell Technical College, Surrey. Two student health visitors began training in September 1968 and qualified in September 1969. One student attended Ewell Technical College, Surrey, and one student attended Croydon Technical College. All four students have joined our staff. Four qualified Fieldwork Instructors continued to receive students attached for training from various colleges. In 1968 one Health Visitor attended a management course and two Health Visitors attended a post-graduate refresher course. In l969 tnree Health Visitors attended a post-graduate refresher course. In addition Healtn Visitors attended several one-day or half-day conferences on subjects of special interest. - 54 - Health Visitors attached to General Practice In accordance with Department of Health and Social Security Circular 13/69, which recommends attachment of Health Visitors, etc., 4 Health Visitors were attached to general practitioners during 1969: 1 to a partnership in North Cheam and 3 to the General Practitioners at Robin Hood lane Health Centre. DOMICILIARY MIDWIFERY AND HOME NURSING The Domiciliary Midwifery and Home Nursing Service is operated from Nurses Homes in Cheam, Sutton and Wallington. The Department of Health and Social Security Circular 13/69 requested the attachment of nurses and, if possible, midwives to general practitioners., This policy was gradually implemented during the latter part of 1969, when 3 District Nurses were attached to 2 partnerships and arrangements were made for 3 midwives to attend general practitioners midwifery sessions. With increasing attachment it was foreseen that three Nurses Homes were not necessary in the Borough and recommendations were made that all the Home Nursing and Midwifery Services should be centralised at Cheam Nurses Home by using the existing Home for residential accommodation for pupils and building a Clinical Centre in the grounds of the Home. The following tables give some indication of the volume of work carried out:- HOME NURSING 1969 1968 1967 (a) Total number of persons nursed 3153 2828 2902 (b) Number of persons aged under 5 at first visit 34 43 59 (c) Number of persons aged 65 or over at first visit 2093 1849 1955 (d) Total number of visits made by home nurses 122186 112510 111283 DOMICILIARY MIDWIFERY Year Number of domiciliary confinements attended by Midwives under N.H.S. arrangements No. delivered in institution but discharged to D.M. before the 10th day. Total No. of visits made by D.M. Doctor booked Doctor not present Total Doctor present Doctor not present 1969 51 219 - 270 529 9684 1968 94 293 7 394 378 9106 1967 125 326 l 452 355 9991 - 55 - The following table shows the number of visits made by midwives to give ante-natal care:- Total visits made during the year: 1969 4769 1968 5291 1967 7166 (a) Midwives booked cases transferred to hospital during confinement During 1969, 26 patients were transferred to hospital during pregnancy or labour and were delivered by domiciliary midwives in hospital. (b) Refresher Courses for Midwives, District Nurses and Pupil Midwives Refresher Course attended: 1969 1968 1967 Midwives 2 l 3 District Nurses 6 7 6 Practical Work Instructors Course attended: District Nurses - 1 2 District Nurse Training Student District Nurses, including 1 overseas student in 1968, who completed training and passed the examination 8 7 7 3 State Enrolled Nurses undertook a course of instruction and all passed the assessment and examination and were awarded the Queen's Certificate in 1969. Pupil Midwifery Training 1969 1968 1967 Pupil Midwives who undertook 3 months of their second period of training with the Borough: 28 30 33 Student Nurses taken by District Nurses and Midwives for observation visits from: General and Children's Hospitals 110 82 125 Nurses who were doing obstetric nurses training 20 23 20 - 56 - (c) The following table shows the work undertaken at the Ante-Natal and Post-Natal Clinics during 1968 and 1969:- No. of Sessions held by No. of women in attendance No. of attendance Total No. of Sessions Medical Officers Midwives For A.N. Exam. For P.N. Exam. M.O. Sessions Midwife Sessions Total Attendances 1969 *337 246 548 6l 806 1831 2637 583 1968 198 227 624 83 811 2254 3065 425 1967 260 288 1030 45 1052 2439 3491 548 * Each ante-natal session at which cytology examinations are made are counted as complete ante-natal sessions. (d) Ante-Natal. Mothercraft and Relaxation Classes Number of women who attended during 1968 and 1969:- Year Institutional booked Domiciliary booked Total Total No. of attendances during year 1969 582 12 594 2354 1968 427 62 489 2260 1967 422 85 507 2409 (e) Local Supervising Authority (Midlives Act) The Borough Council as the Local Supervising Authority are responsible for supervising the work of all midwives in the Borough. The following number of State Certified Midwives gave notice of their intention to practise as midwives in the Borough during the years 1969 and 1968:- 1969 97 1968 89 1967 103 (f) Summoning of Medical Aid During the period 1st January 1968 to 31st December 1969, medical aid was summoned under the Midwives Act, 1951 by midwives in the following number of cases:- - 57 - 1969 1968 1967 (i) For domiciliary cases:- (a) Where the medical practitioner had arranged to provide the patient with maternity medical services under the National Health Service 147 124 119 (b) Others - - 1 (ii) For cases in hospitals 353 308 421 (g) Ophthalmia Neonatorum Between 1st January 1968 and 31st December 1969, midwives sought medical aid for suspected cases of Ophthalmia Neonatorum in respect of lb babies in 1969 and Ik in 1968, but no cases were notified. (h) Notification from Midwives During the period 1st January 1968 to 31st December 1969, the following notifications were received from midwives:- 1969 1968 1967 Sending for medical aid 501 432 541 Stillbirths 2 6 7 Liability to be a source of infection (inc. pyrexia) 10 11 10 Death of mother or baby - - - (i) Special Investigations The non-medical Supervisor of Midwives undertook the following special investigations during 1st January 1968 to 31st December 1969. 1969 1968 1967 Sending for medical aid (all were concerned with conditions of babies' eyes.) l4 11 l6 Stillbirths 267 Liability to be a source of infection (incl. pyrexia) 10 11 10 Death of mother or baby - - 1 (j) Maternity Outfits A maternity outfit is supplied free on request to each expectant mother being confined at home who makes use of one or other of the arrangements for the care of expectant mothers under the National Health Service. (k) Maternal Mortality There was one death associated with pregnancy assigned to the London Borough of Sutton during the period 1968 and 1969 - a young girl who was not known to be pregnant until post-mortem. - 58 - LAUNDRY SERVICE FOR INCONTINENT PATIENTS NURSED AT HOME This service for incontinent patients continues to operate as in previous years. The number of patients in need of assistance decreased slightly during the years under review. This worthwhile service is very much appreciated, not only by patients but also by those who are caring for people unfortunate enough to be in need of this type of personal comfort. The following information gives the number of patients served. Total during year Number of patients on books at the end of year 1969 1968 1967 1969 1968 1967 London Borough of Sutton 72 74 98 33 33 35 London Borough of Merton 101 123 l45 51 48 54 Borough of Epsom & Ewell - - 1 - - - 173 197 244 84 81 89 DAY NURSERY SERVICE Children are admitted to the Council's Day Nursery: (i) Where the mother is the sole wage earner (ii) When there is sickness in the family or where home conditions are likely seriously to prejudice the health of the child. (iii) Where, upon consideration of individual circumstances, it appears to the Council that admission is necessary in the interests of the child. The geographical situation of the nursery near to the North West boundary makes it inaccessible to many parts of the Borough, Consequently 5 children in 1969 and 9 in 1968 normally resident attended the nursery in Middleton Road by arrangement with the London Borough of Merton and 1 child in 1969 and 3 in 1968 attended nurseries in other Boroughs, 38 children in 1969 and 11 in 1968 were placed by the Council in private day nurseries, 52 places are available in the Council's nursery, the average daily attendance at which was 39 in 1969 and 38 in 1968. Children attending the nursery are medically examined at six monthly intervals and medical officers and health visitors pay frequent visits. CARE OF THE UNMARRIED MOTHER AND HER CHILD In making provision for the residential care of the unmarried mother and her child the Council rely mainly on voluntary organisations. There is an active Moral Welfare Association in Sutton which runs an 18 bed mother and baby home. The Council makes a grant to the Association and in return receives the services of a moral welfare social worker and free admission of mothers up to one third of the total number of beds available. - 59 - A number of girls prefer to go to mother and baby homes some distance from their places of residence and at times the Sutton home is unable to accept all the Sutton cases. Under these circumstances, a suitable home is sought elsewhere, the Council being financially responsible for the girl's maintenance, less any contribution she may make of her own or from financial help from her parents or the putative father. The total number of Sutton girls admitted to the Sutton Mother and Baby Home from 1st January, 1968 to 31st December, 1969 was 13 in each year and the number recommended for placement in other mother and baby homes was l6 in 1969 and 10 in 1968. Before leaving the home mothers are assisted to find accommodation and employment and in making arrangements for the care of their babies. MOTHER AND BABY HOMES Name and address of Home: Provided by: "The Haven" 2 Camden Road, Sutton. Sutton & District Moral Welfare Association Type of admission Number of cases admitted during year Number of beds at end of year Average duration of stay 1969 1968 1967 1969 1968 1967 Ante-Natal 49 53 61 8 9 9 42 days Post-Natal - - 1 9 8 8 42 „ Shelter - - - - - - - Total 49 53 62 17 17 17 84 days Number of Cots 9 9 9 recuperative holidays Adults and children recommended on medical grounds for recuperative holidays are sent to convalescent and holiday homes. During the period under review ten children (4 in 1969 and 6 in 1968) under the age of five years; thirty two (17 in 1969 and 15 in 1968) school children; and ninety (53 in 1969 and 37 in 1968) adults were sent for recuperative holidays. Patients, excluding school children and those receiving social security benefit, are assessed to pay a contribution towards the cost of their maintenance. DENTAL CARE OF MOTHERS AND YOUNG CHILDREN Mothers are encouraged to bring their children for dental inspection when they attend the Toddlers Clinics which are now held at all the main Centres. In addition, expectant and nursing mothers and young children under 5 years can obtain dental inspection and treatment at the Council's dental surgeries. - 60 - Dental inspection and where necessary, treatment, carried out before the age of 5 years is an important measure in preventive dentistry leading to the early diagnosis of dental defects usually before extensive fillings or extractions are necessary. At this time also advice can be given on diet and oral hygiene and the importance of regular dental inspections is stressed. The numbers of children being brought for inspection and treatment before they are five years of age is gradually increasing, although the number of expectant and nursing mothers attending the Council's clinics is low. Many of these, however, obtain their treatment privately. The following table gives details of work undertaken during the period under review:- -6l- Attendances and Treatment Expectant and Nursing Mothers Children Under 5 1969 1968 1967 1969 1968 1967 Inspection 36 43 50 1118 1289 726 No. found to require treatment 32 42 43 401 485 313 No. offered treatment 30 37 43 377 444 290 Re-inspection 4 11 8 125 283 180 No. found to require treatment 3 9 6 68 167 92 First visits for treatment 36 46 58 394 468 385 Subsequent visits 93 117 111 716 896 621 Total visits 129 163 169 1110 1364 1006 Additional courses of treatment 5 2 8 38 84 58 Fillings 107 137 137 1183 1471 999 No. of teeth filled 88 109 110 1091 1314 878 Extractions 19 57 26 185 193 136 General anaesthetics 11 6 11 96 99 62 Emergency visits 3 6 10 63 58 51 Patients x-rayed 15 24 14 7 6 4 Scalings 10 26 21 20 22 23 Teeth otherwise conserved - - 3 71 48 160 Teeth root filled - 2 - 1 - - Crowns - 1 l - - - Inlays - - 1 - - - No. of Dentures supplied 11 13 10 1 - - Courses of treatment completed 19 28 59 362 424 330 Sessions devoted to inspection and treatment 14.55 18 19.85 176.8 238 167.6 - 62 - HOME HELP SERVICE Recruitment of full-time home helps continues to be difficult and the Service is dependent almost exclusively on part-time home helps. Posts of domestic auxiliary on salaries with car allowances have been established, but it is regretted that there have been no suitable applicants. In spite of the chronic shortage of home helps, no household in urgent need is ever left without help. The following table shows the number of households for whom the Home Help Service was made available during the years 1968/69:- Home Help to Households for Persons: 1968 Aged 65 or over on first visit Chronic Sick and T.B. Mentally Disordered Maternity Others Total No.of cases 929 77 - 107 93 1,206 Number of Home Helps at (a) Whole-time 14 31.12.68 (b) Part-time 82 (c) Whole-time equivalent 52.8 of (b) (d) Total 66.8 1969 Acute & Chronic T.B. & Chronic Acute Maternity Mentally Total Over 65 Under 65 Under 65 Disordered No.of cases 948 135 108 74 3 1,268 Number of Home Helps (a) Full-time 13 at 31st December 1969. (b) Part-time 102 (c) Whole-time equivalent of (b) 59.6 (d) Total 72.6 CERVICAL CYTOLOGY During the years 1968/69, the scheme of cervical screening was continuously extended as is shown on the following table:- 1969 1968 1967 Total number of women who had one or more cervical smears taken 2695 1429 1098 Cases having smears taken for the first time 1838 813 815 Number of repeat smears 857 6l6 283 - 63 - Classification of smears Class No. of smears No. referred to G.P. 1969 1968 1967 1969 1968 I 1875 858 349 221 173 II 812 569 738 194 183 III 6 l 9 6 1 IV 1 1 2 1 1 V 1 — - 1 - In all cases complete pelvic examination, breast examination, urine testing and blood pressure recording was routinely carried out, in addition to the cervical smear test. Although the National scheme for cervical smears is for women over the age of 35 years, the Consultant Cytologist at St. Helier Hospital is carrying out a research programme which includes a younger age group and women over the age of 25 years who have had more than one child are also eligible. CHIROPODY SERVICES The following groups are eligible for chiropody under the Council's scheme:- (i) Elderly persons, i.e. persons of pensionable age, receiving retirement pensions. (ii) Handicapped persons including registered blind and partially sighted, and (iii) Expectant mothers. The following table gives the total number of cases attended and the total number of treatments:- 1969 1968 1967 Total number of cases attended 2735 2504 2641 Total number of treatments 10,950 9465 12,367 In addition to sessions held at the major clinics, chiropodists visit Local Authority Residential Homes for the Elderly and 3 private Homes run by Voluntary Organisations. Where the elderly or handicapped person is unable to attend a clinic, domiciliary visits are made and the following are the numbers of these visits:- 1969 1966 1967 Treatments given in patient's own home 3709 3190 3899 There is an increasing demand for chiropody but unfortunately, during the years 1968/69, it has not been possible to recruit full-time chiropodists and at times there has also been difficulty in obtaining the services of sessional chiropodists. - 64 - THE CARE OF THE MENTALLY HANDICAPPED During the two years covered by this report the establishment of the Mental Health Section has increased and now has an effective strength of 9 officers one officer on secondment for training. Mental Illness 527 referrals were received from all sources during 1968 and of this number 236 patients required inpatient treatment in psychiatric hospitals; 67 being admitted on an informal basis and 169 under statutory procedures. This compared with 613 referrals received during 1969, whom 296 patients required inpatient treatment; 114 being admitted on an informal basis and 182 under statutory procedures. At 31st December 1968 148 patients were being supported in the community and at 31st December 1969 the number being similarly supported was 216. Hostel Gower House Hostel has been reasonably well occupied during the two years covered by this report and the position during each year was as follows: 1968 - Admissions 15 Discharges 17 In residence at 31st December 1968 10 1969 - Admissions 13 Discharges 13 In residence at 31st December 1969 10 7 patients were in residence in hostels or voluntary homes outside the Borough at 31st December 1968 and this number increased to 12 by 31st December 1969. Boarding Out Scheme The boarding out scheme continues to be disappointing. No further progress has been made during the two years covered by this report and only two flatlets which are occupied by previous residents from Gower House Hostel represent the sum total of this venture. Officers are ever watchful to find landladies interested enough to participate in the scheme and it is hoped that progress will be made. Social Club The social club run by the Sutton Association for Mental Health continues to meet every Tuesday at the Day Centre, 77 Woodcote Road, Wallington, from 8.00 - 10.00 p.m. The Chairman, Secretary and voluntary helpers provide a varied programme and attendance at the club remained fairly steady throughout the last two years. Subnormality Subnormal children over 5 years of age and adults capable of receiving day training attended various training centres within and outside the Borough during the years 1968 and 1969 as follows:- - 65 - 1968 1969 Sutton Training Centre 35 children 38 children Morden Junior Training Centre 8 children 3 children (London Borough of Merton) Banstead Adult Technical Training Unit 60 adults 63 adults (Surrey County Council) Caterham Training Centre 2 adults 2 adults (Surrey County Council) 1 child 1 child Waylands Training Centre (London Borough of Croydon) 1 adult 1 adult Bensham Training Centre (London Borough of Croydon) 1 adult 1 adult Croydon Spastic Work Centre 1 adult 2 adults Croydon Spastic Childrens Centre 4 children 5 children St. Bernadettes Schools Ltd. 2 children 1 child. We are grateful to neighbouring Authorities for assisting us by offering places in their training centres. Hostels The number of cases where special arrangements were made for subnormal children and adults who needed to be in residential establishments for care and training increased from 11 in 1968 to 18 in 1969. Hospitals During 1968 and 1969 14 and 19 applications respectively were received for short term care to enable the parents to have a holiday or because of a family crises and with the co-operation of Queen Mary's Hospital, Carshalton, and The Manor Hospital, Epsom, all were admitted for periods ranging from two to eight weeks. Two submormal females were received into permanent residential care in hospitals for the subnormal during the year ending 31st December, 1968, and during the year ending 31st December,1969, 4 male and 2 females were similarly received into permanent care. Community Support The Mental Health Section has responsibility for supporting all subnormal persons over 5 years of age in the community and these are visited as frequently as possible having regard to officers case loads. At 31st December, 1968, 219 families were subject to routine visiting. This increased to 23O at 31st December, 1969. As in previous years holiday arrangements for adults attending the Banstead Technical Training Unit were made by the Surrey County Council. A few children from the Sutton Training Centre were able to join parties of Surrey children on organised holidays; 5 in 1968 and 6 in 1969, we are grateful to Surrey County Council for their assistance. Training Centre It was hoped that by 31st December, 1969, the new purpose built Training Centre would be in course of erection and that the centre would be operational before another winter, but it now appears doubtful whether the Centre will be completed before the administration of training centres and the responsibility for the training of the subnormal are transferred to the Education Department. - 66 - General For emergency rota duty of Mental Welfare Officers outside normal office hours at night and at week-ends the link has been maintained with the neighbouring Borough of Merton. This arrangement operates very satisfactorily and it is intended that it should continue. MEDICAL SOCIAL WORK 1. Prevention of Break-up of Families When the Department was reorganised in July 1968, the Sub-Section of the previous Health and Welfare Department concerned with the prevention of breakup of families was transferred to the Social Services Division® 2. Chest Clinics One Medical Social Worker has remained attached to the Chest Clinics at St. Helier Hospital and with one Chest Clinic Health Visitor works in close co-operation with the Consultant Chest Physicians. Their work, which was originally associated almost exclusively with cases of pulmonary tuberculosis, has been extended to other chest and heart conditions. There are two Chest and Heart Voluntary Committees:- Beddington, Carshalton and Wallington Chest and Heart Care Committee, and Sutton and Cheam Tuberculosis and Chest Care Committee, who give excellent service to patients attending the Chest Clinics on the recommendation of the Chest Physician or the Chest Clinic Social Worker. The Borough Council makes an annual grant to the Care Committees, but much of their work is dependent on the raising of funds from voluntary sources. Extra-nourishment Patients suffering from pulmonary tuberculosis, who require extranourishment for medical reasons and are unable to provide it themselves are supplied with free milk. There is a diminishing need for this scheme, since the number of necessitous patients suffering from pulmonary tuberculosis is gradually reducing. HEALTH EDUCATION In addition to work in this field carried out by teachers in schools, many of the professional staff of the Health Division of the Department, Medical Officers, Dental Officers, Health Visitors are responsible for Health Education as part of their normal duties. The demand from schools an from the general public has increased greatly and it became necessary to appoint a Health Education Officer, assisted by a Technical Assistant, to co-ordinate the work and to give supporting service to professional staff as well as to participate in practical work. These two officers were appointed during 1969. - 67 - A Health Education Centre was set up in Rochester Road Clinic and a considerable number of Audio-visual aids have been obtained and are in constant use in Clinics, schools, etc. The Department is grateful to Head Teachers for a financial contribution towards the purchase of a number of Health Education Films. Health Education Sessions are held in clinics, schools, public Halls etc., and it is only possible in this report to refer to the more important sessions that were held. l) Courses on preparation for childbirth and parentcraft were held in clinics throughout the Borough by Health Visitors and the following table will indicate the number of sessions helds- 1968 1969 Mothercraft sessions 303 301 Parentcraft sessions 85 102 Total 388 421 2) Health Education in High Schools has been undertaken by Dr.L.Clowes throughout the years 1968/69, following a pilot scheme in one school. During the school term, Dr. Clowes is employed almost fulltime on Health Education and her programme is geared to all ages in High Schools. Head Teachers have frequently expressed their appreciation of the talks given. In addition to her sessions in schools, Dr. Clowes has frequently attended Parent/Teacher Association meetings giving talks on special aspects of her Health Education programme in high schools and showing the appropriate films to the parents. Health Education sessions are also held in primary schools by Health Visitors and it was possible to increase the number from 48 sessions in 1968 to 200 in 1969. 3) Home Safety. Work in connection with the prevention of accidents in the home continued throughout 1968 and 1969 with a varied programme. This included home safety courses, primarily for young people, certificates of merit being presented to the successful participants; open days at fire stations; a poisons campaign associated with the collection from homes and at chemists shops of unused drugs and medicines and poster competitions in schools. Hazard House, the teaching aid which highlights 53 home hazards has been improved and has been continuously in use in primary schools, libraries, etc. Hazard House has, in fact, become wellknown throughout the Country and on a number of occasions has been loaned to outside organisations. The Department is grateful for the continuous help given by the Home Safety Committee and the Home Safety Officer in this important part of our Health Education Programme. - 68 - NURSING HOMES Hie following registered nursing homes are situated in the Borough:- Carshalton Nursing Home Ltd., 28 Salisbury Road, Carshalton. 103 Woodcote Road, Wallington. Dunollie, 38 Woodcote Road, Wallington (closed during 1969) The Avenue, 32 The Avenue, Cheam. The Red House, 40 Burdon Lane, Cheam. St. Margaret's, 17 Overton Road, Sutton. Woodcote Grove House, Woodcote Park, Coulsdon (Friends of the Poor and Gentlefolk's Help). The following establishments are also registered as "Nursing Homes" ;- St. Anthony's Hospital, Cheam. Lourdes House, Wallington (For Mentally Sub-normal Children) The Haven, Camden Road, Sutton (Mother and Baby Home). Nursing Homes are visited regularly by medical officers and the senior nursing officers. NURSES' AGENCIES ACT, 1Q57 There are 2 nurses' agencies licensed under this Act in the Borough:- The Empire Nursing Association Carshalton Nurses' Co-operation(Moved from area in 1969). Licences are issued annually subject to re-inspection and satisfactory report. NURSERIES AND CHILD MINDERS REGULATION ACT, 1948 The above act was amended by the Health Services and Public Health Act, 1968, Section 60. The main purpose of the amendment was to register all child minders whereas in the past registration was not necessary where the child minder had the care of one or two children only. In addition there were recommendations to improve the standard of care of children either being looked after by child minders or in private day nurseries. The following tables will indicate the tremendous increase in the volume of work necessarv due to the amendment of the acts:- Year Approved for registration during the year: No. who cancelled registration during the year: Child Minders Day Nurseries Child Minders Day Nurseries 1969 89 5 7 1 1968 7 10 12 1 1967 14 8 - 2 - 69 -  Nurseries & Child Minders Regulation Act 1948 National Health Service Act,1946. Section 22. Premises Registered at end of year Daily Minders registered at end of year Daily Minders receiving fees from the Authority at the end of year Factory Other Nurseries (a) Number as at: 31.12.69 - 45 117 6 31.12.68 - 43 45 1 31.12.67 - 34 45 3 (b) Number of places and number of children minded as at: 31.12.69 - 1054 337 7 31.12.68 - 997 285 1 31.12.67 — 799 318 4 MEDICAL ARRANGEMENTS FOR CHILDREN'S HOMES AND RESIDENTIAL NURSERIES At 31st December, 1969, there were 4 Children's Homes and one Reception Home under the control of the Children's Committee:- Reception Home, Rosebery House, 7/9 Rosebery Road, Cheam Throwley House, 10 Throwley Road, Sutton Malvern House, Kenley Camperdown Children's Home, Wallington Dean House, Merstham. A general practitioner residing near the Reception Home has been appointed as medical officer and is. responsible for the examination of new admissions and discharges, as well as for medical treatment. At the other Homes a general practitioner is responsible for medical treatment, examination of new admissions and discharges being carried out by senior medical officers. In addition, a senior medical officer visits all the Homes regularly, carries out routine medical inspections every six months and is responsible for seeing that any special investigations and immunisations against infectious disease are carried out. The Children's Homes are inspected every six months and a report on environmental conditions and the health of the children submitted to the Children's Committee as necessary. - 70 - STAFF MEDICAL EXAMINATIONS (a) Officers A medical examination to ascertain fitness for employment is carried out by the Medical Officer of Health or a member of the medical staff as soon as possible following interview and before an appointment is confirmed. The medical examination includes a routine x-ray examination of chest for all members of the staff having close contact with children and those who have been exposed to tuberculous infection. X-ray examination of other members of the staff is carried out when the examining medical officer considers it is desirable. Bacteriological and other investigations may be required at the discretion of the Medical Officer of Health* (b) Manual Staff A medical examination to ascertain fitness for employment is carried out by the Medical Officer of Health or a member of the medical staff within 6 months of first being employed and no further medical examination is required prior to acceptance into the Superannuation Scheme. Manual staff who are in close contact with children and those who have been exposed to tuberculous infection have an x-ray examination of chest and at the discretion of the Medical Officer of Health, bacteriological examination of stools or any other investigation considered necessary. (c) Employees of the Council generally Certain members of staff having close contact with children are required to have a periodic x-ray examination of the chest, for example, Health Visitors, District Nurses, Child Care Officers, etc. A similar condition was introduced for teaching and ancillary staff at schools in September 1969. Under certain circumstances members of the staff are granted an extension of sick leave. Members of staff referred by Chief Officers to determine fitness to continue employment are medically examined. Members of staff who wish to continue employment after the age of 65 years are required to pass a medical examination and are re-examined annually. The following medical examinations were undertaken during 1968 and 1969:- 1969 1968 1967 Officers (excluding teachers) 322 338 245 Teachers 281 266 219 Manual Staff 224 284 247 Extensions of Sick Pay 24 77 100 Retirement due to ill-health 11 17 26 Extensions of service 128 136 82 - 71 - Trainee Teachers It is part of the duty of school medical officers to medically examine entrants to teachers' training colleges. In 1969 and 1968, 160 and l64 respectively, examinations were carried out and the reports were forwarded to the Principals of the Training Colleges concerned. The number for 1967 was 155. SCHOOL HEALTH SERVICE 1. Selective Medical Examinations A full report on selective medical examinations was contained in the Annual Report of 1967 and was put into operation in September 1967. The selective medical examination has not diminished the volume of work to such an extent as was anticipated, since many of the parents have requested their children to be medically examined whether selected or not. About 80% of all the children in the age groups concerned are still medically examined. 2. Periodic Medical Inspections Tables (a) and (b) give details of the number of children examined Medical Inspection of Pupils Attending Maintained Primary and Secondary Schools (including Nursery and Special Schools) Table (a) Periodic Medical Inspections 1st January - 31st December 1969 Age Groups Inspected (by year of birth) No. of Pupils who have received a full Medical Examination PHYSICAL CONDITION of Pupils Inspected No. of Pupils found not to warrant Medical Examination (See Note 1 above) Pupils found to require treatment (excluding dental diseases and infestation with vermin) Satisfactory Unsatisfactory For defective vision (excluding squint) For any other condition recorded at Part II Total Individual Pupils No. No. (1) (2) (3) (4) (5) (6) (7) (8) 1965 & later 295 293 - 12 17 29 1964 1712 1711 1 56 156 195 1963 947 946 1 27 115 142 1962 171 171 - 18 19 35 1961 1376 1376 - 89 128 165 1960 455 454 1 37 47 82 1959 82 82 - 8 10 l6 1958 44 43 1 6 14 20 1957 722 718 4 260 100 82 177 1956 333 333 - 113 54 28 74 1955 120 120 - 21 21 4l 1954 & earlier 1120 1120 - 175 75 230 TOTAL 7375 7367 8 373 603 712 1206 - 72 - Of the 7375 pupils examined in 1969, 1206 pupils (percentage of total l6.35) were found to be in need of treatment for l459 defects. Table (b) Periodic Medical Inspections 1st January - 31st December 1968 Age Groups Inspected (by year of birth) No. of Pupils who have received a full Medical Examination PHYSICAL CONDITION of Pupils Inspected No. of Pupils found not to warrant Medical Examination Pupils found to require treatment (excluding dental diseases and infestation with vermin) Satisfactory Unsatisfactory For defective vision (excluding squint) For any other condition Total Individual Pupils (No.) (No.) (1) (2) (3) (4) (5) (6) (7) (8) 1964 & later 232 231 1 - 4 16 18 (205) (204) (1) (-) (3) (25) (28) 1963 1076 1073 3 - 38 83 103 (1620) (1614) (6) — (75) (182) (247) 1962 319 317 2 - 20 45 54 (452) (451) (1) - (17) (75) (89) 1961 86 86 — — 9 19 23 (100) (100) - - (6) (15) (18) 1960 1359 1359 - - 127 121 224 (1352) (1351) (1) - (125) (130) (222) 1959 435 434 1 - 47 50 89 (434) (432) (2) - (43) (74) (104) 1958 77 77 - - 10 24 28 (71) (69) (2) - (6) (22) (25) 1957 37 57 - 251 4 21 22 (132) (132) (229) (24) (29) (45) 1956 665 663 2 111 85 64 129 (377) (374) (3) (104) (58) (41) (71) 1935 371 370 1 3 51 39 86 (207) (205) (2) (-) (24) (25) (36) 1954 122 122 - - 23 20 39 (99) (99) - - (19) (14) (28) 1953 1177 1176 1 — 212 78 252 (298) (1298) (-) - (235) (1ll) (315) TOTAL 5976 5965 11 365 630 580 1067 (6347) (6329) (18) (333) (635) (743) (1228) - 73 - Of the 5976 (6347) pupils examined in 1968, 1067 (1228) pupils (percentage of total 20.57 (19.35) ) were found to be in need of treatment for 1421 (1662) defects. (i) Special medical inspections and re-inspections Pupils are re-examined when necessary following periodic medical inspections or can be referred for examination by the Head Teacher and School Nurses or if requested by parents. These pupils are examined either at the school or at general medical clinics. The total numbers re-examined were as follows:- 1969 184 1968 1006 1967 1028 (ii) Physical condition The general physical condition was considered to be unsatisfactory in a very small number of pupils as the following table shows :- 1969 1968 1967 a) Children examined at routine medical inspection: 7375 5976 6347 b) No. in unsatisfactory physical condition: 8 11 18 c) (b) as a percentage of (a) 0.11% 0.19% 0.28% (iii) Personal Hygiene Routine inspection of personal hygiene of pupils is carried out either at the school nurse's discretion, or at the request of the Head Teacher. Regular hygiene inspections each term have not been considered necessary. The following table shows the total number of children inspected and the total number of cases of infestation:- Year No. of children examined. No. found to be infested. 1969 8261 99 1968 2657 14 1967 7006 44 - 74 - defects found by periodic and special medical inspections NOTE: All defects, including defects of pupils at Nursery and Special Schools, noted at periodic and special medical inspections are included in this table, whether or not they were under treatment or observation at the time of the inspection., This table includes separately the number of pupils found to require treatment (T) and the number of pupils found to require observation (0). Defect Code No. Defect or Disease PERIODIC INSPECTIONS Special Inspections Entrants Leavers Others Total 1969 1968 1967 1969 1968 1967 1969 1968 1967 1969 1968 1967 1969 1968 1967 4 Skin T 24 18 28 35 37 48 63 81 73 122 136 149 293 307 347 O 82 53 51 27 11 39 55 66 55 164 130 145 - 47 1 5 Eyes a. Vision T 95 62 97 196 235 260 312 333 278 603 630 635 65 48 84 O 167 116 153 46 79 39 275 247 150 488 442 342 8 23 8 b. Squint T 53 31 43 5 1 1 25 35 29 83 67 73 2 11 2 O 43 28 15 2 - - 16 21 8 61 49 23 - 1 1 c. Other T 6 1 8 1 2 - 8 10 7 15 13 15 4 6 6 O 9 2 5 - 1 2 4 6 6 13 9 13 - - 2 6 Ears a. Hearing T 17 12 25 5 3 5 18 13 13 40 28 43 87 2 147 O 90 39 56 6 7 11 50 58 43 146 104 110 - 45 10 b. Otitis Media T 7 3 4 — — 3 l 16 3 8 19 10 1 6 4 O 89 34 46 2 2 4 17 31 25 108 67 75 - 1 - c. Other T 2 1 1 1 1 3 4 7 5 7 9 9 4 81 6 O 11 5 8 2 1 - 6 3 59 19 9 67 - - - 7 Nose and Throat T 72 35 51 3 4 9 51 35 39 126 74 99 9 11 18 O 633 277 435 22 27 41 233 306 223 888 680 699 2 14 11 8. Speech T 70 32 59 3 3 5 27 34 40 100 69 104 27 10 26 O 166 69 89 2 2 — 19 27 14 187 98 103 - 10 - - 75 - Defect Code No. Defect or Disease PERIODIC INSPECTIONS Special Inspections Entrants Leavers Others Total 1969 1968 1967 1969 1968 1967 1969 1968 1967 1969 1968 1967 1969 1968 1967 9 Lymphatic Glands T 2 2 2 - - - 1 1 1 3 3 3 - - 2 O 137 77 161 3 3 5 49 67 55 189 147 221 - 4 - 10 Heart T 3 1 4 1 1 3 4 3 9 8 5 16 1 - 4 O 71 24 41 4 5 15 25 20 28 100 49 84 - 1 4 11 Lungs T 16 5 17 2 5 5 18 17 36 36 27 58 9 8 20 O 118 46 57 22 11 18 77 70 33 217 127 108 - 16 3 12 Developmental a. Hernia T 1 2 1 1 - - - 4 5 2 6 6 1 — — O 13 3 4 - 1 - 1 9 11 l4 13 15 - - - b. Other T 13 2 9 5 1 2 33 7 18 51 10 29 9 5 6 O 56 27 72 11 3 1 49 46 74 116 76 l47 - 5 1 13 Orthopaedic a. Posture T 2 4 13 6 8 13 6 17 30 l4 29 58 9 l4 21 O 9 6 19 7 7 20 l4 29 30 30 42 69 1 6 - b. Feet T 26 16 30 6 4 11 31 38 47 63 58 88 28 39 57 O 61 38 52 21 7 22 42 51 60 124 94 134 - 9 - c. Other T 22 6 12 9 5 11 12 9 15 43 20 38 21 4 18 O 35 20 24 18 l4 20 21 39 35 74 73 79 - 13 1 14 Nervous System a. Epilepsy T 3 2 2 - 3 6 4 6 11 7 11 19 1 2 3 O 7 4 3 3 4 - 9 6 1 19 l4 4 - 2 - b. Other T 3 - — 1 2 2 4 1 1 8 3 3 2 2 2 O 5 8 8 4 2 1 12 6 10 21 18 19 — 1 - 15 Psychological a. Development T 3 4 1 27 31 17 31 97 96 61 132 ll4 21 8 21 O 57 34 31 2 3 5 29 25 18 88 62 54 - 12 1 b. Stability T 11 7 5 4 5 4 17 20 19 32 32 28 11 4 20 O 78 4l 81 7 5 14 37 59 74 122 105 169 — 2 7 16 Abdomen T 1 1 2 5 2 2 - 5 10 6 8 l4 5 2 1 O 30 8 18 8 2 10 26 17 21 64 27 49 - 2 — 17 Other T 3 6 13 - 9 9 18 17 29 21 32 51 223 227 295 O 20 19 41 9 21 22 4l 62 53 70 102 116 - 66 11 - 76 - 3. Medical Treatment Medical treatment is the responsibility of the general practitioner and hospital services with the exception that certain minor ailments are also treated at Local Authority Clinics. By arrangement with the Executive Council treatment of defective vision and squint is carried out at Local Authority Ophthalmic Clinics. (a) Minor Ailments The principal minor ailments treated are diseases of the skin and ear and external disease of the eyes. One of the School Medical Officers has specialised in the treatment of diseases of the skin and many cases are referred to her by general practitioners. 1969 1968 1967 Total No. of Pupils treated for minor ailments: 222 88 291 Total No, of pupils treated for skin diseases: 292 325 352 (b) Eve diseases, defective vision and squint Ophthalmology Sessions are held at the following clinics:- Robin Hood Lane Health Centre Green Wrythe Lane Clinic Rochester Road Clinic Shotfield Clinic Total numbers of pupils treated for these defects were as follows:- 1969 1968 1967 External eye diseases: 435 Defective vision including squint: 1381 1349 1188 Total No, treated: 1385 1352 1193 Spectacles were prescribed for: 347 402 381 (c) Diseases and defects of ear, nose and throat 1969 1968 1967 Total No. of children treated for these defects: 122 105 222 No. who received operative treatment: 5 8 28 (d) Orthopaedic and postural defects Physiotherapy Sessions for minor orthopaedic and postural defects are held at the following clinics and at Carew Manor Special School:- Priory Crescent Rochester Road Stonecot Hill Green Wrythe Lane Robin Hood Lane Shotfield - 77 - SCHOOL DENTAL SERVICE 1968/1969 There is an increasing awareness on the part of the general public of the need for regular dental attention and the demand for dental treatment at the Borough's Clinics continues to grow. To encourage this trend, especially in the younger age groups, school entrants were given an attractive card on dental health and a sample tube of toothpaste in 1968 and in 1969,an oral hygiene kit, consisting of a beaker, toothbrush and toothpaste. Infants and Primary Schools were supplied with colourful wall charts, designed especially for young children, and a film loop showing the correct way to use a toothbrush was run at intervals at all the Dental Clinics. The maintenance of an efficient dental service in all five clinics is a difficult task, mainly due to the rapid turnover of staff, but the dental officers were co-operative, working extra sessions or changing their centres of work to keep the clinics running as smoothly as possible. In spite of staff changes the total number of dental sessions rose during the years 1968 and 1969 but some school inspections had to be postponed. The percentage of children found to be in need of treatment was higher, (1968 48.6%; 1969 50.5%) but still compared favourably with the national average of 56.5%. The pattern of dental treatment over the country as a whole, tends to vary from one area to another, depending on the number of dental surgeons available in the area, and the demand for conservative treatment. In Sutton the demand for conservative treatment is high and the average of 7.1 fillings to .85 extractions per treatment session compares favourably with the national average of 5.2 fillings to 2.1 extractions per session. - 78 - SCHOOL DENTAL SERVICE 1. Attendances & Treatment 5-9 years 10-14 years 15 years & over TOTAL 1969 1968 1967 1969 1968 1967 1969 1968 1967 1969 1968 1967 First Visit 1812 1926 1899 1522 1648 1540 334 309 322 3668 3883 3761 Subsequent Visits 3167 3282 2872 3102 3484 2974 718 754 630 7047 7520 6476 Total Visits 4979 5208 4771 4624 5132 4514 1112 1063 952 10715 11403 10237 Additional courses of treatment commenced 407 554 415 216 321 213 43 59 55 666 934 683 Fillings in permanent teeth 1855 1935 1284 3782 4218 3265 1173 1222 1066 6810 7375 5615 Fillings in deciduous teeth 4l66 4690 4684 330 485 470 - - - 4496 5184 5154 Permanent teeth filled 1541 1656 1105 3219 3557 2682 968 1000 883 5728 6213 4670 Deciduous teeth filled 3720 4167 3863 286 415 369 - - - 4oo6 4582 4232 Permanent teeth extracted 29 59 71 315 364 384 79 64 67 423 487 522 Deciduous teeth extracted 1001 823 832 4oo 354 251 - - - 1401 1177 1083 General Anaesthetics 479 407 420 256 268 229 26 21 21 760 696 670 Emergencies 212 255 207 73 93 63 33 26 14 308 374 284 1969 1968 1967 Number of Pupils x-rayed 298 273 174 Prophylaxis 286 253 409 Teeth otherwise conserved 179 111 300 Number of teeth root filled 10 32 19 Inlays 1 1 2 Crowns 9 14 12 Courses of treatment completed 3658 3836 3526 - 79 - 2. Orthodontics 1969 1968 1967 Cases remaining from previous year 338 366 (321) New cases commenced during year 57 100 (182) Cases completed during year 72 83 (70) Cases discontinued during year 72 37 (51) No. of removable appliances fitted 95 100 (96) No. of fixed appliances fitted - - (-) Pupils referred to Hospital Consultant 12 8 ( 2) 5. Prosthetics Ages 5-9 Ages 10-14 Ages 15 & over Total 1969 1968 1969 1968 1969 1968 1969 1968 Pupils supplied with F.U. or F.L. - - - 1 1 1 1 (first time) (-) (-) (-) (-) Pupils supplied with — - 3 2 1 — 4 2 other dentures (first time) (-) (1) (-) (1) Number of dentures - 1 4 4 2 1 6 6 supplied (1) (4) (1) (6) 4. Anaesthetics General anaesthetics administered by Dental Officers 1969 1968 Nil Nil (nil) 5. Inspections 1969 1968 (a) First inspection at school No. of pupils 16075 14923 (16790) (b) First inspection at clinic No. of pupils 2326 2082 (1955) No. of (a)+(b) found to require treatment 9293 8284 (8748) No. of (a)+(b) offered treatment 7484 6606 (7295) (c) Pupils re-inspected at school clinic 1983 2592 (1095) No. of (c) found to require treatment 1324 1809 (808) 6.Sessions 1969 1968 Sessions devoted to treatment 1602.5 1729.55 (1551.15) Sessions devoted to inspection 164 153.4 (165) Sessions devoted to Dental Health Education 2 2o5 (10). - 80 - SPECIAL SERVICES (a) Audiology Service The early diagnosis of children with partial hearing is essential if normal progress is to be achieved in the development of speech and the child's education. The great majority of cases are diagnosed by hearing screening tests before the child begins school. Those children initially referred on account of speech defects which may be associated with partial deafness have a routine hearing test by the audiometrician before speech therapy is commenced and all pupils have a further screening test during their second year at school. Those children who show any defect in hearing are referred to the school medical officer who decides whether it is necessary for them to be referred for further investigation and treatment. In cases where there is a severe loss of hearing the pupil is referred to an ear, nose and throat specialist and a decision made regarding the supply of a hearing aid. In a small number of cases the pupil is considered sufficiently handicapped to require special educational treatment at a partial hearing unit or special school for the deaf. In the less serious cases it may only be necessary to request the head teacher to make certain that the pupil sits near the front of the class and in those cases with loss of hearing in one ear, be placed with the good ear towards the teacher. The co-operation of teachers in this respect is much appreciated. 1969 1968 New Cases supplied with hearing aids 9 2 (6) Pupils registered as having been fitted with hearing aids 41 35 (37) Total Number of children seen by Audiometrician 2191 2156 (2095) Number found to have defective hearing of varying degree and referred to School Medical Officers for further investigation 116 262 (166) (b) Speech Therapy Speech Therapy Clinics were held at Priory Crescent Clinic, North Cheam; Rochester Road, Carshalton; Green Wrythe Lane, Carshalton; Shotfield, Wallington; and Robin Hood Lane, Sutton. The total number of children treated for Speech Therapy during the year 1969 was 262 (220) The total number of children treated for Speech Therapy during the year 1968 was 279 One of the Speech Therapists carried out 3 (4) sessions weekly at Carew Manor E.S.N. School. (c) Child Guidance Service The staff of the Child Guidance Clinic work closely with their colleagues in other sections of the Health and Family Services and Education Departments and with Probation Officers, psychiatric colleagues in Hospitals and particularly closely with general medical practitioners. Educational Psychologists working in the School Psychological Service are based at the Child Guidance Clinic thus creating a closely integrated service. Because of the nature of the work - 81 - and the widely varying factors which are connected with psychiatric disturbance both in family welfare and in education, it is essential to achieve the closest possible working arrangements. In many cases referred to the Clinic, after diagnostic interview, treatment at the Clinic is not regarded as appropriate but referral is made to the most appropriate agency, while support is given and progress followed by the Child Guidance Clinic staff. Maladjusted children in need of special schooling are referred through the Education Department to the school considered most appropriate. Work is at times continued in the Clinic with the parents while the child is at a boarding school for maladjusted children. A close relationship has evolved between the Child Guidance Clinic and the North Downs Special School where the work that is done for the child is therapeutic in a school setting. In all cases both parents as well as the child are given psychiatric interviews and in many cases they are all offered treatment; the parents with a psychiatric social worker and the child with the child psycho-therapist. The number of children referred to the Clinic in the period under review was as follows:- 1969-130, 1968-93 (1967-101). The agencies initiating referral were:- 1969 1968 1967 General practitioners 6l 38 48 School Health Service 16 16 16 School Psychological Service 26 18 18 Courts 6 4 5 Probation Office - 2 1 Children's Section 12 5 8 Hospitals or Specialists 4 4 4 Schools 4 1 1 Education Department 1 4 - N.S.P.C.C. - 1 - 130 93 101 The number of families who withdrew from the waiting list or failed their diagnostic appointments were as follows:- 1969-8, 1968-13, 1967-10. Psvchiatrist Sessions 1969 1968 1967 Diagnostic interviews with children 108 82 86 Treatment interviews 267 227 344 Court reports 5 3 4 Boarding school reviews 9 4 9 Case discussions (supervision) 39 60 106 Discussion of North Downs cases 17 17 16 Meeting outside agencies 39 22 28 Outside visits - - 3 Appointments arranged but failed 31 27 32 - 82 - Psychiatric Social Worker Sessions 1969 1968 1967 Treatment interviews 878 1066 1100 Case discussions 76 203 246 Meeting outside agencies 26 33 12 Home visits 32 6 27 Supervision of student 38 32 9 Outside visits 7 - 11 Appointments arranged but failed 127 185 144 Psychotherapist Sessions Treatment interviews 1256 1107 849 Case discussions 90 131 169 Outside visits 3 2 1 Meeting outside agencies 5 5 1 Appointments arranged but failed 143 112 105 (d) School Psychological Service This service is administered independently from the Child Guidance Clinic but works in parallel with it. It is staffed basically by one full-time and one half-time Educational Psychologist and in March 1968 a further Psychologist joined the service on a sessional basis. The service was also involved in the supervision of Educational Psychology Diploma students in the academic years 1967/68 and 1968/69. The service attempts to assess the potential and difficulties for any pre-school or school child referred for advice and a total of 345 (1968) and 730 (1969) children were seen. The following table summarises the source of referral and the main recommendations made. It will be seen that a comparatively small number of children were referred to the Remedial Units in the Borough. This is because of the limited number of places available at remedial units at the moment. However, there are plans in co-operation with the Education Officers for improving remedial provision in the junior and secondary schools. The two Infant Observation and Diagnostic Classes were set up in September 1968, fulfilling a most important need and the service is happy to co-operate with the Medical Officers in the selection of children for these classes as we do in many other spheres. Besides these vital links with the Administrative Services for Health and Education it is important to note that the majority of our referrals come directly from the Head Teachers themselves and the service values the close contact with the schools. Two sessions a week in term are devoted to visits to Carew Manor School where the review scheme inaugurated by the Head Master continues successfully. School Psychological Service Source of Referrals 1969 1968 Principal School Medical Officer 246 108 Head Teachers directly 300 148 Carew Manor E.S.N. School 130 66 Other 54 23 TOTAL 730 345 - 83 - Main Recommendations made: 1969 1968 To Carew Manor 47 26 To Training Centre 7 4 To Infant Observation/Diagnostic Classes 37 19 To Borough Remedial Units 51 16 To other Schools 39 11 To Child Guidance Clinic referral 50 25 Hospital Investigation 31 10 Youth Employment Officer 10 9 Speech Therapist 5 2 Children's Department 5 4 Specific review and reassessment 240 119 Report and advice only 208 100 TOTAL 730 345 Child Guidance Clinic cases assessed by Psychologists 57 1968 75 1969 (e) Infectious Diseases Full information concerning infectious disease is given in that part of the report dealing with infectious disease generally. It should be noted that there were no cases of serious infectious disease in schools during the years 1968/1969 and it was not necessary to carry out any special investigation in respect of cases of pulmonary tuberculosis in members of school staffs or pupils. (f) Immunisation and Vaccination Responsibility for immunisation and vaccination is placed on the Local Health Authority by Section 26 of the National Health Service Act, 1946 Sessions are held regularly at primary schools mainly for reinforcing procedures for protection against diphtheria, tetanus and poliomyelitis B.C.G. vaccination against tuberculosis is carried out at the age of approximately 13 years in secondary schools. The policy of the Education Committee of giving adequate protection against infectious disease for children going abroad in school parties has been continued, the protection necessary being dependent upon the country to which the party was travelling. Exceptions are made very rarely on conscientious objection by the parents. - 84 - HANDICAPPED PUPILS It is the duty of the Council to make suitable provision for handicapped pupils in the Borough. The Handicapped Pupils and Special Schools Regulations 1959 specify ten categories of handicapped pupils, namely:- Blind, partially sighted, deaf, partially hearing, educationally sub-normal, epileptic, maladjusted, physically handicapped, delicate and speech defect. Children who are handicapped in one or more of these ways may require special educational treatment if they cannot be educated satisfactorily under the normal conditions of an ordinary school. The majority, however, do not require to attend a special school since suitable arrangements can be made for them to receive appropriate education in ordinary schools. SPECIAL SCHOOLS There is one special school provided by the Borough Council: Carew Manor, Wallington, for educationally sub-normal children. There is also North Downs, Belmont, a small unit for maladjusted children. In addition placements are obtained in special schools of other Local Education Authorities and in a few cases in specialised private schools. (a) Carew Manor School This special school is a day school for 140 educationally sub-normal boys and girls aged from 7-l6 years. The average number of pupils attending during 1968 was 124 and during 1969 was 139. Before a child is admitted to this or any other special school for educationally sub-normal children a full medical examination is carried out and reports are obtained from an educational psychologist and if necessary from a psychiatrist. Every child attending the school has a physical examination annually and is psychologically assessed every 2 years. At the request of the headmaster or the parents these examinations can be arranged at short notice at any time. - 85 - HANDICAPPED PUPILS Number of pupils registered as handicapped:- 1969-223; 1968-203. Handicapped pupils requiring education at Special Schools approved under Section 9 (6) of the Education Act 1944, or Boarding in Boarding Homes during the years 1st January-31st December 1968 and 1969. Blind Partially Sighted Deaf ially Hearing Physically handicapped Delicate Maladjusted E.S.N. Epileptic Speech Defects Total Children newly assessed as needing special educational treatment at special schools 69 68 69 68 69 68 69 68 69 68 69 68 69 68 69 68 69 68 69 68 1969 1968 - - 5 - - 1 4 3 9 4 7 5 16 6 25 23 - - — — 66 if2 (-) (-) (2) (-) (2) (7) (7) (18) (1) (-) (37) Number of children receiving special educational treatment in (a) Boarding Special Schools or Homes 1 1 2 2 - - 2 2 6 3 10 8 7 5 14 12 1 1 - - 43 34 (1) (2) (1) (2) (3) (10) (9) (13) (-) (-) (41) (b) Day Special Schools - - 10 7 8 10 - - 12 15 6 6 5 7 120 111 - - - - l6l 156 (-) (6) (12) (4) (14) (6) (104) (-) (-) (150) (c) Independent Boarding Schools - - - - - - - - 2 - - - 26 11 1 2 - - - - 29 13 (-) (-) (-) (1) (1) (2) (16) (8) (-) (-) (28) Figures in brackets refer to 1967 - 86 - In addition to a regular weekly session at the school by a school medical officer and educational psychologist, two physiotherapy sessions are held each week and 4 sessions are devoted to speech therapy. Before any pupil leaves the school at the age of l6 a full medical and psychological investigation is carried out and, in conjunction with the headmaster, a decision is made regarding the type of employment that might be suitable for the pupil. In some cases because the pupil might not be accepted into employment or may drift from one job to another, supervision and community care by mental health social workers is recommended. To assist in finding suitable employment the Principal Youth Employment Officer devotes several sessions at the school to interviewing school leavers and their parents. It is regrettable that educationally sub-normal pupils cannot be admitted to Carew Manor School before the age of 7 years. An increasing number of pupils at ordinary schools are now ascertained as educationally sub-normal by the age of 6 years and these children have to be found places in schools in neighbouring authorities. (b) North Downs Unit This Unit caters for 3 groups of maladjusted children. The children remain on the register of their ordinary school and attend the Unit for varying periods from 1 to 4½ days each week. In September 1968, the Unit was transferred to new premises at Cotswold Road, Sutton, which gave them an extra classroom and facilities for extra remedial work, and a playing field. The children recommended for admission to the Unit are carefully selected in conjunction with the Child Psychiatrist and the Head Teacher of the Unit. Many maladjusted pupils require continued contact with their homes and parents which can only be achieved by provision of day school places. The Head Teacher of the Unit continues to have close contact v/ith the parents of the pupils attending the Unit. The number of new admissions to the Unit were 13 (1969) and 13 (1968). (c) Autistic Unit at Queen Mary's Hospital School In September 1968, a second class for autistic children was established at Queen Mary's Hospital School, the first class having been established in September 1967. Both classes cater for a maximum of 5 children. Most of the children admitted have been long-stay residents in Queen Mary's Hospital, but children living in the community also attend. The children are mostly non-communicating and are considered to be either autistic, psychotic or severely emotionally disturbed. They are carefully selected for the classes by a Consultant Psychiatrist who makes the recommendation for their admission. Each class is staffed by a full-time teacher, who has experience of this type of child, and a nurse supplied by Queen Mary's Hospital. A speech therapist, educational psychologist and teacher of the deaf attend the classes regularly. - 87 - Each terra a conference is held, attended by all concerned with the children in the Unit to discuss their progress and placement. Children can also be admitted to the Unit for a diagnostic and assessment period. This has proved most valuable in helping to decide a child's most suitable future placement. 1969 1968 No. of children attending Unit 9 11 No. of children discharged 2 4 No. of children attending Unit who are: a) long-stay residents in Queen Mary's Hospital 10 9 b) from the community 2 2 No. of children transferred from Unit to placements at : a) The Fountain School 1 2 b) Residential home for severely subnormal children with daily attendance at Sutton Training Centre 1 c) Day hospital care - 1 d) School for maladjusted children 1 - A number of children attending the classes have made satisfactory progress, but it is now realised that children must be admitted as soon as the diagnosis has been made, usually in the age group 2-5 years. It is hoped that a nursery class will be commenced in 1970. (d) Queen Mary's Hospital School When a child is admitted to hospital it is essential to continue his or her education as soon as he or she has sufficiently recovered from illness to do so, At Queen Mary's Hospital School some of the pupils can attend classrooms but the majority have individual tuition in bed. A number of children are in hospital for a short time only but a significant percentage are in hospital for a period of months or even years. In addition to the head teacher there are 29 assistant teachers and the curriculum at the school is as varied as in any other school. The total number of children on the register at 31st December 1968 was 156 and at 31st December 1969 was 136. (e) Belmont Hospital School At Belmont Hospital there is a diagnostic unit basically for deaf children. The children are referred from a very wide area in the South of England and the unit specialises in the examination of children for deafness. - 88 - Many of these children are found to be not suffering from deafness but to be non-communicating (Autistic) children. A number may be in the unit for a few days only when the diagnosis has not proved difficult but others remain for a period of months. There are 12 beds in the hospital for these children, the beds almost always being occupied, and the children suitable for education attend classes run by a teacher of the deaf and one part-time teacher of the deaf both of whom are attached to the unit. (f) Other Hospitals Tuition has also been arranged at the following hospitals:- 1968 1969 St.Helier Hospital Children's Unit 21 13 Royal Marsden Hospital 3 2 Wandle Valley Hospital 1 - (g) Home Tuition Some children may be so severely handicapped as to be unable to attend a day school. During the waiting period for admission to a residential school or if the handicap is only of a temporary nature the education of the children is continued in their own homes. 1968 1969 Home Tuition was arranged- Period 1st January - 31st December 6 8 (h) Convalescent Treatment School children are recommended for convalescence or recuperative holidays, either by the family doctor, hospital or school medical officer. Holidays were arranged for 15 children in 1968 and 17 children in 1969• I am grateful to the Chief Education Officer for the following information (a) Employment of Children of School Age The by-laws regulating the employment of children provide for their medical examination prior to employment and annual re-examination. 1968 1969 No. of children examined 382 339 (b) Physical Education in Schools The wide range of physical activities pursued in schools continues to expand. Particular interest in individual and small number activities has been noted, although the popularity of team games continues to flourish. Senior pupils have taken part in residential courses in outdoor activities at the Bowles Centre, Kent; Outward Bound activities in Wales; coastal navigational exercises on the training barge 'Thalatta' in the Blackwater - 89 - estuary; and in recreative activities at the Crystal Palace National Sports Centre. This latter course has given pupils an opportunity to experience such activities as judo, squash, badminton, fencing and ice skating, as well as many more traditional sports. A Borough ski party to Switzerland in which over one hundred pupils took part, was organised during the Christmas holidays, 1969/70. Other provision was made by way of a residential school leavers' course held at Henley, and a sailing course at the Thames Young Mariners' Base, Ham, one evening per week during the Summer Term, 1969. (c) Provision of Meals and Milk in Schools - 90 - The number of day pupils receiving mid-day meals and milk per day both at maintained and non-maintained schools was :- 1968 1969 Average meals numbers: Maintained Schools l2+,978 16,035 Non-Maintained Schools 352 *t00 TOTAL 15,330 16,435 Average milk numbers: Maintained Schools 10,910 11,750 Non-Maintained Schools 1,262 1,3^5 TOTAL 12,172 13,095 HEALTH SERVICES DIVISION PART III INDEX Page No. INTRODUCTION 92 HOUSING 94 RENT ACT, 1957 95 CARAVANS 96 FOOD AND DRUGS 96 INSPECTION OF FOOD PREMISES AND ACTION TAKEN 110 CLEAN AIR ACT, 1956-SMOKE CONTROL AREAS 112 SUMMARY OF AIR POLLUTION MEASUREMENTS FOR 1968 113 WATER SUPPLY ll6 PREVENTION OF DAMAGE BY PESTS ACT 120 NOISE ABATEMENT 120 SHOPS 120 OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 120 SWIMMING BATHS 123 HAIRDRESSERS AND BARBERS 123 MORTUARIES 123 PUBLIC CONTROL 123 DISEASES OF ANIMALS ACT, 1950 124 RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 124 FERTILISERS AND FEEDING STUFFS 124 RADIO-ACTIVE SUBSTANCES ACT, 1960 124 SUMMARY OF COMPLAINTS, INSPECTIONS AND WORK DONE 125 MR. H. Geo. Cripps, M.R.S.H., F.A.P.H.I., Chief Public Health Inspector INTRODUCTION I am pleased to report on the work of the Public Health Inspectors during the period under review. Many factors, including change of office accommodation, reduced establishment and the impact of additional duties and responsibilities have necessarily had a frustrating effect on the staff and a prejudicial effect on the output of the Division. However, in the main, progress has been maintained and details of the work done are set out in the following pages. There are, however, no grounds for complacency. Considerable problems have to be faced in practically every aspect of the work. In the field of Housing, whilst the number of unfit houses to be dealt with is not excessive, progress is impeded by the conflicting claims of "preservationists" whose interests still tend merely to delay action without regard to those who are inadequately housed. The rate of clearance of unfit houses must be increased. Surveys of parts of the Borough, including those parts to be included in Smoke Control Areas, have not revealed any suitable for Improvement under the legislation prior to the 1969 Act. The coming into force of that Act has emphasised the need for more urgent consideration to be given to the question of Improvements generally and General Improvement Areas in particular. The surveys must be extended and co-operation with other Officers interested in this field strengthened. The new legislation has, however, placed a further burden on the staff available. Before the end of the period nearly 400 applications for Qualification Certificates relating to controlled tenancies had been received. Where houses have all the standard amenities and are in a good state of repair a Certificate is issued to owners, enabling them to commence negotiations with the Rent Officer for the determination of a fair rent. Inspections of the houses in order that the Authority could be satisfied that the conditions had been met were commenced, and in the majority of cases it will be necessary to indicate to applicants works which will be required to bring the houses up to the standard. Without increases in staff the impact of this function, as it increases in momentum, must result in a reduced coverage of other important routine functions, notably the inspection of food premises, shops, offices and factories which necessarily suffer when more immediate matters have to be given priority. Other aspects of housing which will continue to call for supervision to prevent nuisances and damage to the amenities are those of "gipsy" caravans and houses in multiple occupation. During the period under review the former policy of moving caravans has been relaxed and as a result the number of vans is increasing. Every effort should be made to provide a permanent site with supervision and adequate facilities, with a view to the integration of the van dwellers and particularly the children into the community. The routine inspections of houses in multiple occupation must be continuous and the standards strictly enforced. In the field of pest control difficulties have arisen from failure to maintain an adequate staff in view of more attractive opportunities generally available, and to recruit operatives suitable for these duties and capable of working satisfactorily in the field with the minimum of supervision. Steps are being taken to improve this position to enable rodent control to be maintained and at the same time accommodate additional land pest control duties which will pass from the Ministry of Agriculture, Fisheries and Food to Local Authorities shortly. - 92 - The sampling and inspection of imported foods have been transferred from Port Health Authorities in accordance with the requirements of the Imported Food Regulations 1968 and it is anticipated that with increased use of containers these duties will increase. The supervision of food premises continues to be a major responsibility and in this connection it will clearly be necessary to accept every opportunity, both in the field and by courses of lectures, of improving the knowledge of food handlers in relation to hygiene methods and the possible results of their failure in this direction. The smoke control programme has been vigorously pursued and it is a matter for regret that an anticipated shortage of solid smokeless fuels must have a prejudicial effect on this effort. Steps will, however, be taken to overcome any delays which are already apparent, with the intention of completing the programme within the estimated period. - 93 - HOUSING Clearance of Unfit Houses: In 1968 the owner of one house was released from his undertaking under Section l6 of the Housing Act 1957, the house having been made fit for habitation,, Summary of Action taken under the Housing Acts with regard to Unfit Houses: 1968 1969 Total Number of Properties Affected Clearance Areas Declared 2 2 19 Clearance Orders Confirmed - 4 19 Individual Unfit Houses dealt with by- (a) Demolition Orders - 8 8 (b) Closing Orders - 4 4 Inspection and Action taken under Statutory Powers: 1968 1969 Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 6,710 6,112 Number of inspections for the purpose 9,040 9,197 Number of dwelling houses found not to be in all respects reasonably fit for human habitation 372 277 Action under Statutory Powers during the year. PROCEEDINGS UNDER SECTIONS 9, 10 and 12 OF THE HOUSING ACT 1957. Number of dwelling houses in respect of which notices were served requiring repairs 177 202 Number of dwelling houses which were rendered fit after service of formal notices By owners - - By Local Authority in default of owners - - PROCEEDINGS UNDER PUBLIC HEALTH ACTS. Number of dwelling houses in respect of which formal notices were served requiring defects to be remedied 64 47 Number of dwelling houses in which defects were remedied After informal action by Local Authority 167 225 After formal notice under Public Health Acts 73 20 - 94 - Legal proceedings were instituted against the owner of premises to enforce a notice served under Section 93 of the Public Health Act 1936. An order was made by the Court for repairs to the premises to be carried out. Houses in Multiple Occupation: Of the 15 houses inspected in the two-year period, all were found to be houses to which the Houses in Multiple Occupation Regulations apply. During the period 4 houses were brought up to the standard acceptable to the Council. Housing Act 1969: Three hundred and forty-five applications for Qualification Certificates were received. Housing Act 1957-Part IV (Overcrowding): All known cases of overcrowding were reviewed during 1968/69. The information obtained is summarised below:- 1968 1969 (a) (1) Number of dwelling houses overcrowded at the end of the year 6 5 (2) Number of families dwelling therein 7 7 (3) Equivalent number of adults dwelling therein 44½ 39 (b) Number of new cases reported during the year 2 5 (c) (1) Number of cases of overcrowding relieved during the year 3 6 (2) Number of persons concerned in such cases 15 40 (d) Particulars of any cases in which dwelling houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding RENT ACT 1957 The following details show the action which has been taken during the year:Part I-Application for Certificate of Disrepair: (1) Number of applications for certificates 1 2 (2) Number of decisions not to issue certificates 1 Nil (3) Number of decisions to issue certificates- (a) in respect of some but not all defects Nil Nil (b) in respect of all defects Nil Nil - 95 - 1968 1969 (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule Nil 2 (5) Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule Nil Nil (6) Number of certificates issued Nil Nil Part II - Application for Cancellation of Certificates: (7) Application by landlords to Local Authority for cancellation of certificates 2 Nil (8) Objections by tenants to cancellation of certificates 2 Nil (9) Decisions by Local Authority to cancel in spite of tenants' objection 2 Nil (10) Certificates cancelled by Local Authority 2 Nil CARAVANS The Council, by proceeding under Section 57 of the Surrey County Council Act, 1931, now have Orders prohibiting the use of the land for the parking of moveable dwellings within a radius of 880 yards of the sites at Cuddington Way, Cheam, and Green Lane, Worcester Park. On three occasions during 1968 vans were found to have been parked on the land at Cuddington Way and Green Wrythe Lane and Revesby Road, Carshalton. Steps were taken to ensure their early removal. Towards the end of 1969 the number of itinerant vans coming into the Borough began to increase. FOOD AND DRUGS Inspection and Supervision of Food Premises: 1968 1969 Inspections 2,658 2,135 Notices re unsatisfactory conditions 162 122 Complaints re adulterated and unsound food 166 181 Legal Action 1 Nil - 96 - Articles of food containing foreign bodies or mould were as follows:- Article No. No. 1968 1969 1968 1969 Baby Food 1 1 Fruit 1 3 Beverage 1 - Meat 7 18 Bread 17 22 Meat Pies 2 8 Butter 1 1 Milk 3 15 Cereals 1 3 Milk Bottles (contaminated or chipped) 15 8 Cheese 2 2 Confectionary Flour 15 10 Preserves 2 - Confectionery Sugar 2 5 Sausages 2 6 Cordial 1 - Sugar 1 - Cream 1 1 Tea - 2 Fish 2 2 Vegetables - 4 Yoghurt 2 3 The following samples were taken for bacteriological examination:- Milk: Classification of the milk samples and the results of the tests are as follows:- Designation under which sold No. of Samples Methylene Blue Test Phosphatase Test Turbidity Test Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory 1968 1969 1968 1969 1968 1969 1968 1969 1968 1969 1968 1969 1968 1969 Pasteurised 75 81 73 79 2 2 75 81 - - - - - - Ultra Heat Treated 3 5 3 5 — - 3 5 - — — - — - Untreated 4 - 2 - 2 - - - - - - - - - Sterilised 12 4 - - - - - - - - 12 4 - - 94 90 78 84 4 2 78 86 - - 12 4 - - - 97 - Ice Cream: Bacteriological examination of ice cream samples taken were reported upon as follows:- 1968 1969 Grade I 59 Grade II 3 2 Grade III 2 - Grade IV 3 - Unsatisfactory results were investigated and subsequent reports from the same sources proved satisfactory. Other Foods: Bacteriological examination of 245 items were made during the period. Satisfactory reports were received. Water: Twenty-five samples of water were reported as satisfactory during 1968/69. Registration of Milk Distributors; The number of Milk Distributors registered under the Milk and Dairies (General) Regulations 1959 increased from 67 in 1968 to 79 in 1969. Designated licences in force, under the Milk (Special Designation) Regulations 1963 (as amended) during the year were as follows:- 1968 1969 Dealer's (Pre-packed Milk) Sterilised 6l 67 Pasteurised 8l 91 Untreated 24 25 Ultra Heat Treated 36 41 Dealer's (Pasteuriser's) 1 1 Unsound Food: The following quantities of food found to be unsound, diseased or unwholesome and unfit for human consumption were surrendered and destroyed?- - 98 -  Unwrapped Food Wrapped Food Number of Containers 1968 1969 1968 1969 lbs. ozs. lbs. ozs. Beverages - - - - 4 23 Cereals - - - - 82 15 Cheese 148 0 959 8 371 95 Confectionery Flour - - 30 0 1,603 928 Confectionery Sugar - - 268 0 417 51 Cream - - 21 galls. 21 3 Fats and Oils 269 0 64l 0 875 - Fish 291 8 242 0 2,270 661 Frozen Food 996 0 1,176 4 7,308 33 Fruit 16 10 66 0 1, 444 1,118 Fruit Juice - - - - 76 l4o Ice Cream - - - - 138 835 Meat 2,333 4 12,254 5 - 275 Meat Canned - - 19 0 275 288 Meat Cooked 12 0 341 0 131 145 Milk - - - - 4o 31 Preserves - - 7 0 99 36 Sausages - - 768 8 8 68 Soup - - - - 326 41 Vegetables 4 0 84 0 1,918 1,082 Miscellaneous 120 0 1,362 0 1,479 1,529 4,190 0 18,218 9 18,885 7,397 - 99 - Slaughterhouses: There are no slaughterhouses in the Borough. Food Hygiene (Markets. Stalls and Delivery Vehicles) Regulations 1966 (as amended): Inspections of stalls and delivery vehicles during the period indicated that the informal approaches in 1967 had, in some instances, been disregarded. Legal proceedings were therefore instituted to secure compliance with the requirements in relation to five bread and cakes delivery vehicles and five street traders selling fruit and vegetables from stalls. In two instances relating to stalls the hearings were adjourned following undertakings being given that the Regulations would be satisfied, and the summonses were subsequently withdrawn. In the eight other cases the proceedings resulted in the imposition of fines. Adulteration of Foods The table below is a summary of the total 973 samples of food and drugs (482 in 1968 and 491 in 1969) which were purchased for examination by the Public Analyst, Mr. J.A. Palgrave, B.Sc., F.R.I.C. Food Samples - Chemical Analysis 1968 and 1969 Formal Informal Adulterated Total Formal Informal 1968 1969 1968 1969 1968 1969 1968 1969 1968 1969 Alcoholic Drinks 4 4 2 1 - - - - 6 5 Beverages 2 2 8 13 - - - - 10 15 Cereals and Cereal Products 3 3 24 15 - - 2 1 27 18 Cheese 2 - 8 11 - - - - 10 11 Confectionery Flour - - 14 8 - - - - 14 8 Confectionery Sugar - 1 14 21 - - 1 1 14 22 Cream 1 - 6 6 - - ~ - 7 6 Drugs - 2 37 20 - - - 3 37 22 Fat and Oils 7 1 6 15 1 - 1 - 13 16 Fish and Fish Products 2 1 10 12 - - - - 12 13 Fruit and Fruit Products 2 1 20 24 - - 1 2 22 25 Ice Cream 20 1 2 2 - - - - 22 3 Meat and Meat Products 7 3 19 23 - - - 1 26 26 Milk 28 24 51 54 1 1 1 1 79 78 Milk Products 2 2 12 13 - - - - 14 15 Carried Forward 80 45 233 238 2 1 6 9 313 283 - 100 - Formal Informal Adulterated Total Formal Informal 1968 1969 1969 1968 L968 1969 1968 1969 1968 ] Brought Forward 80 45 233 238 2 1 6 9 313 283 Preserves 3 1 9 17 — — — 3 12 18 Sausages 6 4 3 2 - - 1 - 9 6 Sauce - - 10 4 - - 3 - 10 4 Soft Drinks 5 3 13 15 - - 1 - 18 18 Soup 2 - 14 4 - - - - 16 4 Vegetables and Vegetable Products 4 - 8 24 1 - - 1 12 24 Miscellaneous 5 3 87 131 - - 5 7 92 134 105 56 377 435 3 1 18 20 482 491 TOTAL 1968 482 TOTAL 1969 491 The samples described as adulterated or irregular were reported upon by the Analyst as follows and action was taken as indicated:- 1968 Formal Sample - Bottled Baby Beetroots: A sample of pickled beetroots in a liquid containing 1.2 per cento of acetic acid. The Public Analyst stated that the common or usual name for the article was Pickled Baby Beets and the producers, a Dutch firm, were informed accordingly. Informal Sample - Blackcurrant Health Drink: A sample of blackcurrant Health drink. The label on the container described the article as "Treble Vitamin C enriched" with a minimum content of 60 mg. vitamin C per fluid ounce. In the opinion of the Public Analyst there was no justification for the claim of enrichment. Also, the declaration regarding the artificial sweetener content failed to comply with the Soft Drinks Regulations 1964. The matter was not pursued as the manufacture of the article had been discontinued. Informal Sample - Bread Sauce Mix: A sample of bread sauce mix which had solidified in the carton due to its age. The vendor withdrew the remaining stock pending investigation of the matter by the manufacturers. - 101 - Informal Sample - Chili Powder: A sample of spices, garlic and salt which in the opinion of the Public Analyst should be named either Compound Chili Powder or Mixed Spices and Salt. The producer agreed to change the labelling of the article so as to comply with the opinion of the Public Analyst. Informal Sample-Food Colour: The labelling of the container failed to comply with the colouring matter in the Food Regulations 1966. The manufacturers agreed to revise the labelling of the article so as to comply with these Regulations. Informal Sample - Fruit Salads: A sample of pears, apricots, peaches, pineapple and cherries in syrup. The Public Analyst stated that the proportions of the fruits failed to agree with the Local Authorities Joint Advisory Committee on Food Standards Code of Practice No. 4. The information was forwarded to the canners, who are a Spanish Company. Informal Sample-Instant Low Fat Milk: A sample of skimmed milk powder containing 1 per cent. of milk fat. In the opinion of the Public Analyst the labelling of the article did not comply with the Dried Milk Regulations 1965. The manufacturer has stated that they have now discontinued making this product. Formal Sample-Outline Low Fat Spreads A sample of an emulsion of oils or fats with water and other substances, capable of being used for the same purposes as butter and containing water 55.9 per cento, oil or fat 40.7 per cent., salt 2.6 per cent. A previous, informal, sample of this product was found to contain similar percentages of the ingredients. In the opinion of the Public Analyst the article came within the definition of Margarine contained in the Food Standards (Butter and Margarine) Regulations 1955» and should, therefore, not contain more than l6 per cent. of water. Also, the labelling of the article failed to comply with the Labelling of Food Order 1953. However, after considering information supplied by the manufacturers, the legal officers of the Council advised against the taking of legal proceedings. Informal Sample-Wrapped Malt Cakes: A sample of a fruit malt loaf. In the opinion of the Public Analyst the article should be described as a malt fruit loaf. The bakers agreed to modify the labelling of the product to comply with the opinion of the Public Analyst. Informal Sample-Milk: A sample of milk containing 3.55 per cent, of milk fat and 8.47 per cent. of milk solids other than fat. The Public Analyst stated that although the milk solids other than milk fat content of the milk was slightly below that specified in the Sale of Milk Regulations 1939, the Hortvet (freezing point) test did not indicate the presence of added water. The apparent deficiency was attributed to a normal seasonal variation. - 102 - Formal Sample-Milk: A sample of milk containing 3.64 per cent. of milk fat and 8.18 per cent of milk solids other than milk fat. The Public Analyst stated that judged by the standards specified in the Sale of Milk Regulations 1939 the sample was 3.9 per cent. deficient in milk solids other than milk fat and that on the basis of the Hortvet (freezing point) test there was a presumption that 3 per cent. of water had been added to the milk. A letter of warning was sent to the vendor. Informal Sample-Paprika and Sebinker: A sample of a compound food comprising processed cheese, ham, paprika and spices. The Public Analyst reported that the article did not bear the label required by the Cheese Regulations 1965. The manufacturers stated that their usual stick-on label must have become detached from the sample but that they now proposed to over-wrap the label to prevent a repetition. Informal Sample-Purvio: A sample containing the permitted food colouring matters, Red 10B and Violet BNP in a dilute solution of acetic acid. The Public Analyst reported that the labelling of the article failed to comply with Regulations, now in force, relating to Colouring Matter in Food. The vendor arranged to replace existing stock with new stock correctly labelled. Informal Sample-Canned Skinless Pork Sausages: A sample of skinless pork sausages containing a total meat content of 6l.6 per cent. and fat 30.8 per cent. In the opinion of the Public Analyst the total meat content should have been at least 65 per cent. The manufacturers agreed to modify the descriptive labelling of the article to clarify the information relating to the meat content and thereby conform to the opinion of the Public Analyst. Informal Sample-Redi-Sweet: A sample of a food intended for making a dessert containing 33 per cent. of skimmed milk. The Public Analyst considered that the words "includes the milk" which were imprinted on the carton containing the sample were misleading, as there was no whole milk powder present. The manufacturer agreed to amend the labelling of the product by deleting the offending words. Informal Sample - Rum Truffles: A sample of chocolate with a rum-flavoured truffle filling containing 0.15 per cent. proof spirit. In the opinion of the Public Analyst the correct name for the article was Rum Flavoured Truffles. The manufacturers agreed to change the name of the product to that suggested by the Public Analyst. - 103 - Informal Sample-Cheese Sauce Mix: A sample of an incomplete sauce mix requiring the addition of milk to prepare the sauce. The Public Analyst stated that the necessity to add milk should be stated on the front of the packet. The manufacturers agreed to amend the statement on the packet accordingly. Informal Sample-Spaghetti Sauce Seasoning: A sample of an incomplete sauce mix requiring the addition of tomato puree and butter. The Public Analyst stated that the necessity to add tomato puree and butter should be stated on the front of the packet. The manufacturer submitted a new label for the product which was found satisfactory. Informal Sample-Tartar Sauce A sample of an article containing more than two ingredients. The Public Analyst reported that the label specified one ingredient as "Relish" but, since this was a generic and not specific term, it was not acceptable under the labelling of Food Order 1953. The manufacturer agreed to modify the labelling of the article by replacing the word "Relish" with "Gherkins" - an ingredient of the sauce. Informal Sample-Whole White Pepper: A sample of white peppers which were shrivelled, broken or decomposed. The vendor was informed and immediately withdrew his remaining stock from sale. 1969 Informal Sample-Chopped Virginian Ham A sample of cured meat deficient in meat. The article contained total meat 80.5% and in the opinion of the Public Analyst it should contain not less than 90%. The Producers were informed accordingly. Informal Sample - Blackcurrant Conserve A sample deficient in soluble solids to the extent of 1%. The Manufacturers were advised and reported that the sample was one of an isolated batch of jam deficient in soluble solids. A further sample proved satisfactory. Informal Sample-Redcurrant Jam A sample deficient in fruit to the extent of 43% and bore a misleading label. The sample contained several redcurrants, not more than 20% and the article was descrived as 'whole fruit redcurrant jam' but there was neither seeds nor skins in the jam. The product was imported from abroad and the distributers gave an undertaking to ensure that in future only a high standard of produce would be imported. The label of the product was redesigned. Informal Sample-Beef Stew Seasoning One of the ingredients was declared as M.SG but this was not an - 104 - appropriate designation for the purposes of the labelling & Food Order 1953. The Importers were advised and stated whilst they would agree to declare M.SG as "Monsodium Glutamate" on the label they had sufficient materials on hand to last l8/24 months. It was agreed to allow the existing ones to be used for another 18 months. Informal Sample-Meat Marinade The necessity to add vinegar and oil was not stated on the front of the packet. The manufacturers were advised and relabelled their product. Informal Sample-Whole Ginger This sample was incorrectly named. The Analyst's opinion was that the sample was one of limed ginger containing added calcium carbonate 0.9%. The Importers were advised and discontinued importing the article. Informal Sample-Milk The sample was deficient in milk solids other than milk fat to the extent of 0.5% The Producers when notified, advised that the Milk Marketing Board reported that the long winter had delayed growth of new Spring grass and in certain areas rainfall had prevented cows being turned out and were therefore being stall-fed on last season's hay of rather poor quality. Informal Sample-Olives The sample was stuffed olives in brine and a label bearing the common or usual name list of ingredients and address of the packer of the food was not present on the container. The Producers were advised and enclosed a sample label in general use on their product. The label was acceptable to the public analyst. The vendor later wrote to say the label became detached whilst the article was in his possession. Informal Sample-Cochineal A sample of food colour containing carmine, glycerine, isopropanol and potassium hydroxide solution. The container was not labelled in accordance with Schedule 2 of the Colouring Matter in Food Regulations 1966. The manufacturers submitted a revised label which was acceptable to the Public Analyst. Formal Sample-Milk The sample contained Milk Fat 354 per cent. milk solids other than milk fat 8.33 per cent., and that the Freezing Point (Horbet) of the sample was - 0.531° C. As judged by the Sale of Milk Regulations 1939 the sample is deficient in milk solids other than milk fat to the extent of 2.0 per cent. The Freezing Point (Horbet) indicated the presence of 1.5 per cent added water. The opinion based on genuine bulk milk having a Freezing Point (Horbet) of not less than-0.540° C. The minimum limit of the above named regulations in respect of milk solids other than milk fat is 8.5 per cent. A satisfactory explanation was received from the Producers. - 105 - Informal Sample-Marmalade A sample of orange marmalade deficient in soluble solids to the extent of 3 per cent. The product was of the "home-made" variety and the manufacturer was advised to aim for a stiff set - unless instruments are used to determine the soluble solids. Informal Sample-Chocolate Animals A sample of confectionery made with a chocolate substitute containing a high proportion of vegetable fat other than cocoa butter. Chocolate should be made predominantly with cocoa nibs, sugar and cocoa butter and it should contain no vegetable fat other than cocoa butter. The sample was not of the nature of chocolate. The Importers were advised and sent a display card which should be exhibited with the article when it is offered for sale. The display card was accepted by the Analyst. The product is no longer imported. Informal Sample-Tomato Puree (No. 380.) The Sample had a metallic taste and contained Tin-130 parts per million. The Analyst opinioned the tin content of tomato puree should not exceed 100 parts per million. The Producers accepted the content of 130 parts per million as higher than the figure normally expected in the product but did not consider it excessive bearing in mind the Food Standards Committee's recommended maximum of 250 parts per million. The Public Analyst accepted this and suggested the fault could be cured by use of lacquered cans which some packers use and find both tin level and metallic taste are reduced. If samples containing more than 250 parts per million were found there would be good cause to expect them to be withdrawn from sale. Informal Sample-Tomato Puree (No. 444) The sample had a metallic taste and contained tin-parts per million. The sample was obtained from the same vendor as sample No. 380 above and in view of the absence of an enforcible standard, no further action can be taken in these cases. Informal Sample-Dyspepsia Tablets, The surfaces of some tablets were discoloured to varying degrees and contaminated with iron or compounds of iron on the surface. A thorough investigation by the Drug Company concerned resulted in the production of a report by their Deputy Chief Analyst which was acceptable to the Public Analyst. Further formal samples were satisfactory. Informal Sample-Beef Strogonoff Mix The sample bore a misleading label. The instructions for preparation of the sauce included the addition of butter and sour cream, but the necessity to do this was not stated clearly on the packet. The Manufacture was advised and relabelled the product. - 106 - Informal Sample-Salad Supreme Seasoning A sample of seasoning incorrectly labelled. The list of ingredients included monosodium glutamate and M.SG in two different places. Since M.SG is an abbreviation for monosodium glutamate and is not an appropriate designation for the purposes of the Labelling of Food Order 1953, the inclusion of the term is unnecessary. The Importer agreed to print new labels to conform to the Order. Informal Sample-Cough Syrup A sample of a preparation containing Morphine Acetate 0.0064 per cent. Morphine acetate is included in Part 1 of the Poison List. The container of the article did not bear the name and address of the seller as required by the Pharmacy & Poisons Act 19333. The retailer sincerely regretted the omission which had been caused by pressure of work due to the 'flu epidemic. Informal Sample-Spaghetti with Tomato and Cheese Sauce A sample of heat processed canned food. The can bore the expression "bounty fresh" which in the opinion of the Analyst was not an appropriate description to apply to a canned heat processed food prepared from processed ingredients. The Manufacturers agreed to discontinue the use of the label when existing stock is exhausted. Informal Sample-Iodine The sample was of iodine tincture B.P. containing Iodine 2.58 per cent Potassium Iodide 2.51 per cent and was not of the nature of Iodine. The retailer regretted the incorrect labelling of the product an oversight occasioned by pressure of work due to the 'flu epidemic. Informal Sample-Chocolate Topping The sample contained Benzoic acid 255 parts per million. Benzoic acid is a permitted preservative but its presence in a chocolate topping is not permitted by the Preservatives in Food Regulations 1962. The Importers were advised and stated that the product was produced under licence in this country for a Dutch firm but they have decided to discontinue the sale of the product. - 107 - FOOD SAMPLES-PESTICIDE RESIDUES SURVEY Eighteen samples of food were taken, during a special survey in 1968, for analysis in connection with the Pesticides Residues Survey. Details of the samples taken, and results, are set out belows:- No. of Sample Description Organo-chlorine Insecticides p.p.m. Fly Test Organo-phosphorus Insecticides p.p.m. 1. Brown Loaf Trace of BHC -ve Not detected 2. White Loaf Trace of BHC -ve Not detected 3. English Pork BHC 0.011 -ve Not detected 4. English Cheddar Cheese Not detected -ve Not detected 5. Oven-ready Frozen Chicken BHC 0.021 Dieldrin 0.006 DDT 0.013 -ve Not detected 6. Dripping BHC 0.022 BHC 0.005 Dieldrin 0.054 DDE 0.050 TDE 0.125 DDT 0.0l4 7. Untreated Farm Milk Total BHC Trace Dieldrin Trace -ve Not detected 8. Pasteurised Milk BHC 0.001 BHC 0.002 Heptachlor epoxide 0.00l Dieldrin 0.003 DDE Trace TDE Trace -ve Not detected 9. English Butter BHC 0.022 BHC 0.012 Heptachlor epoxide Trace DDE Trace TDE Trace DDT Trace 10. Pears DDT 1.00 DDE 0.048 TDE 0.111 -ve Not detected 11. Sturmer Apples DDT 0.044 DDE 0.018 TDE 0.056 -ve Not detected As -ve Pb -ve 12. English Strawberries Not detected -ve Not detected - 108 - No. of Sample Description Organo-chlorine Insecticides p.p.m. Fly Test Organo-phosphorus Insecticides p.p.m. 13. Pork Sausages BHC 0.004 BHC 0.005 Dieldrin 0.0l6 DDT 0.040 DDE 0.021 TDE 0.006 -ve Not detected 14. Beef Sausages BHC 0.038 BHC 0.005 Dieldrin 0.015 DDE Trace TDE Trace -ve ( Not detected 15. Lettuce Not detected -ve Not detected l6. English Streaky Pork Rashers BHC Trace BHC 0.005 Dieldrin 0.001 DDT 0.002 DDE 0.013 TDE 0.003 -ve Not detected 17. Tomatoes Not detected -ve Not detected 18. Onions Not detected -ve Not detected The IMPORTED FOOD REGULATIONS 1968, which came into force on 1st August permitted sealed containers to be forwarded to inland destinations for examination at the place of unloading by authorised officers of the receiving authority. Containers with a wide range of spices were examined and some three dozen samples were taken in 1968 and 55 in 1969. The goods were of a high standard but it was found necessary to arrange for the importing company to amend some labels. - 109 - INSPECTION OF FOOD PREMISES AND ACTION TAKEN 1968 SANITARY ACCOMMODATION FOOD STORAGE AND PREPARATION ROOMS No. of Premises No. of Premises registered under Sec.16 of Food & Drugs Act Repaired Cleansed and/or Decorated Lighting provided Washing Facilities (incl. Hot and Cold Water) Nail Brush and Soap provided 'Wash Your Hands' Notices Repaired Cleansed and/or Decorated Lighting provided Ventilation provided Washing Facilities for Food and Equipment First Aid Materials provided Accommodation for Clothing provided Ac cumulations removed Bakehouses 14 - 1 2 1 1 - _ - 2 1 - - - - - Bakers & Confectioners 43 12 - 1 - 1 1 1 - 1 - - - 1 - - Butchers 105 95 1 6 1 4 3 2 6 13 - - 5 2 2 4 Canteens 105 - - - - 1 - - - 3 - - - - - - Chemists 4l 1 - - - - - - - l - - - - - - Confectioners (Sugar) 20? 189 - - - 2 1 - - l - - - - - - Fishmongers 42 18 - 2 - 3 1 - l 1 - - l - - - Greengrocers & Fruiterers 102 28 1 - - 3 1 - l 1 - 1 l - 1 1 Grocers & General Stores 189 161 2 8 3 3 1 3 5 11 - 1 2 2 - 3 Licensed Premises 52 7 1 1 - 1 - - - l - - 1 - - - Milk Storage Depots 3 - 1 - - - - - - - - - - 1 - - Restaurants & Cafes 83 57 1 5 1 6 4 1 3 12 - 1 4 2 - 6 Factory Food 5 5 - - - - 2 - - - - - - - - - Stalls & Vehicles Food VARIABLE - - - - 3 - - - 4 - - 4 2 - 3 573 8 25 6 28 14 7 16 51 1 3 18 10 3 17 - 110 - "A" INSPECTION OF FOOD PREMISES AND ACTIOS. TAKEN 1969 SANITARY ACCOMMODATION FOOD STORAGE AND PREPARATION ROOMS No. of Premises No. of Premises registered under Sec.l6 of Food & Drugs Act Repaired Cleansed and/or Decorated Lighting provided Washing Facilities (incl. Hot and Cold Water) Nail Brush and Soap provided 'Wash Your Hands' Notices Repaired Cleansed and/or Decorated Lighting provided Ventilation provided Washing Facilities for Food and Equipment First Aid Materials provided Accommodation for Clothing provided Accumulations removed Bakehouses 14 - - — - - - - - - — — — — — _ Bakers & Confectioners 44 12 - 2 - 2 1 - - 1 - - - 1 - - Butchers 105 95 - 4 1 4 - - 2 5 - - 3 1 2 1 Canteens 101 - - 1 - 1 1 - 2 4 - 2 2 1 2 - Chemists 42 1 - - - - - - - - - - - - - - Confectioners (Sugar) 207 189 1 1 - - - 1 2 l - - - - - - Fishmongers 41 18 - - - - - - - - - - - - - - Greengrocers & Fruiterers 99 28 - - - 1 - - - l 1 - - - - 1 Grocers & General Stores 186 161 3 6 1 4 6 8 - 13 - - 1 7 1 6 Licensed Premises 59 7 l 3 - 1 - - - 3 - - 1 1 - - Milk Storage Depots 3 - - - - - - - - - - - - - - - Restaurants & Cafes 84 57 l 4 1 4 3 4 2 7 - 1 1 3 2 1 Factory Food 5 5 - - - - - - - - - - - - - - Stalls & Vehicles Food VARIABLE - - - - 4 1 - - 3 - - - 3 - - 573 6 21 3 21 12 13 8 38 1 3 8 17 7 9 - 1ll - "B" CLEAN AIR ACT 1956-SMOKE CONTROL AREAS. 1968 Smoke Control Order No. 17 affecting part of Worcester Park and Smoke Control Order No. 18 affecting part of North Cheam were confirmed by the Minister of Housing and Local Government on the 27th March 1968 and became operative on the 1st October 1968 and 1st December 1968, respectively. This brought the number of areas in operation up to 18, covering an area of 3,798 acres and affecting 25,445 dwellings. In November, two further Orders (Nos. 19 and 20) affecting a total of 46l acres and 3,839 dwellings were made and submitted to the Minister for confirmation. Records of atmospheric pollution by smoke and sulphur during 1968 are set out as follows:- - 112 - LONDON BOROUGH OF SUTTON SUMMARY OF AIR POLLUTION MEASUREMENTS FOR 1968 Stations:- Beddington & Wallington No.2 Carshalton No.4 Sutton & Cheam No.8 Highest Lowest Average Highest Lowest Average Highest Lowest Average Smoke So2 Smoke So2 Smoke So2 Smoke So2 Smoke So2 Smoke So2 Smoke So2 Smoke So2 Smoke So2 January 91 766 05 17 41 159 127 898 07 26 60 186 125 951 10 33 57 192 February 122 314 11 4l 45 153 185 430 17 50 64 194 170 445 15 52 60 180 March 59 246 05 28 20 110 127 405 09 33 39 151 87 332 07 32 32 129 April 58 213 06 29 21 87 72 310 06 47 30 123 64 277 06 40 26 108 May 37 173 05 17 18 68 45 153 08 21 22 67 36 132 08 28 22 68 June 36 163 03 14 14 69 39 169 03 17 16 73 53 159 04 15 16 69 July 24 144 06 25 14 59 40 108 05 27 16 52 28 146 05 28 15 68 August 29 146 06 24 12 55 32 149 04 29 15 49 37 167 08 24 15 55 September 4l 126 02 27 13 48 84 96 03 23 25 48 62 124 03 22 18 50 October 79 286 05 25 24 75 89 271 05 24 28 76 77 289 07 24 26 85 November 85 220 08 23 34 98 142 210 09 36 47 105 139 359 09 34 46 116 December 124 402 04 34 50 149 211 330 11 13 72 162 178 432 12 40 68 195 - 113 - CLEAN AIR ACT 1956 - SMOKE CONTROL AREAS Smoke Control Order No. 19 was confirmed by the Minister of Housing and Local Government on the 6th February 1969 and came into operation on the 1st October 1969. Smoke Control Order No. 20 was confirmed by the Minister of Housing and Local Government on the l4th April 1969 and came into operation on the 1st December 1969. The area of the Borough covered by Smoke Control Orders by the end of 1969 was 4,268 acres and included 29,011 dwellings. In November Orders Nos. 21 and 22 were made by the Council and submitted to the Minister for confirmation. They cover an area within the Borough containing 3,240 dwellings and have an area of 468 acres. It has been intended that these Orders should become operative on 1st October and 1st December 1970 respectively. The suppliers of solid smokeless fuels were unable to give an assurance that adequate supplies of solid smokeless fuels would be available before 1st April 1971; accordingly the proposed operative dates of Smoke Control Orders No. 21 and No. 22 were altered to 1st July and 1st September 1971. Daily records of air pollution by smoke and sulphur dioxide are made by means of apparatus installed at 1) The Health Centre, Shotfield, Wallington. 2) The Library, Manor Park Road, Sutton. 3) The Lodge, Honeywood Walk, Carshalton. The highest, lowest and average readings for the three Stations are set out as follows:- - 114 - SUMMARY OF AIR POLLUTION MEASUREMENTS FOR 1969 Stations:- Beddington & Waillington No.2 Carshalton No.4 Sutton & Cheam No.8 Highest Lowest Average Highest Lowest Average Highest Lowest Average Smoke So2 Smoke So2 Smoke So2 Smoke So2 Smoke So2 Smoke So2 Smoke So2 Smoke So2 Smoke So2 January 123 383 05 23 34 100 205 359 10 32 49 105 202 387 08 30 46 108 February 97 322 09 35 4l 154 193 316 16 39 69 163 138 325 12 38 55 172 March 75 307 12 45 40 176 96 403 18 55 50 211 108 484 16 54 54 204 April 45 197 04 23 16 78 54 209 06 29 25 81 66 270 08 34 23 97 May 33 143 05 18 15 53 63 145 05 12 18 45 41 176 06 15 19 59 June 20 139 01 21 10 63 57 206 04 21 17 75 28 267 05 22 15 78 July 26 84 05 33 12 57 31 66 08 27 18 48 41 92 09 30 19 51 August 30 108 06 26 15 55 39 102 09 26 20 49 37 112 09 22 20 47 September 33 136 06 27 18 67 46 172 06 26 23 71 45 160 10 22 26 60 October 74 382 06 26 25 80 125 381 14 27 42 79 108 376 12 22 24 75 November 49 149 03 29 19 69 90 157 09 32 34 70 70 149 07 23 39 66 December 136 363 07 26 42 147 175 324 10 24 67 145 141 363 10 48 55 149 - 115 - WATER SUPPLY All houses in the Borough have piped water supply. The majority are supplied by the Sutton District Water Company, a few near the northern boundary are supplied by the Metropolitan Water Board. There are private wells at hospitals, factories and a school. The average Fluoride content of the water is 0.1 parts per million. The Sutton Company draws its supplies from wells in the chalk at Carshalton, Woodmansterne, Sutton and Cheam, and is under statutory obligation to soften the water to 9 of hardness. I am indebted to Mr. E.G.B. Gledhill, B.Sc., M.I.Mech. E., M.I.W.E., A.M.I.C.E., A.M.I. Struc.E., Engineer and Manager of the Sutton District Water Company, for the following information relating to 1969:- 1. The total rainfall recorded at Burgh Heath during the year was 717 mm. (28.23 ins.), a decrease of 67.3 mm. (2.65 ins.) compared with the standard 35 year average (1916-1950) of 784 mm. (3O.88 ins.). January was a mild month but February proved comparatively cold with snowfalls and moderate to severe frosts. Snow also fell towards the middle and latter parts of December but amounts generally were small. As in previous years the rainfall at Burgh Heath is assumed to be indicative of the average rainfall over the catchment area on which the Company's wells depend for replenishment, and the above comments refer to this station only. 2. The underground water levels which were high as a result of the exceptional rainfall in the preceding year dropped rapidly in June as the warm weather continued. This fall was halted towards the latter part of October and the levels at the end of December were normal for the time of year. 3. Supply and Consumption. In 1968 the average daily consumption for the year was less than in 1967. In 1969, however, the normal trend was restored and the average daily consumption showed a relatively large increase compared with the corresponding figure for 1968. Much of this increase is attributed to the prolonged spells of warmer weather which, inevitably, increased the demand for water, particularly for garden watering. The comparable figures for 1968/69 are as follows:- 1968 1969 Average daily consumption for year 55.050 C.M.D. (12,111,000 G.P.D.) 58,105 C.M.D. (12,783,000 G.P.D.) Average daily consumption during week of maximum demand 67,950 C.M.D. (14,949,000 G.P.D.) 79.350 C.M.D. (17,457,000 G.P.D.) Maximum daily consumption 71,704 C.M.D. (15,775,000 G.P.D.) 88,000 C.M.D. (19,360,000 G.P.D.) - 116 - Population Supplied. The following table gives the estimated population supplied in 1968 and 1969 based on information furnished by local authorities, hospitals, and institutions. December 1968 290,222 December 1969 300,538 This large increase in the 1969 figure is due to the latest census figures becoming available from the Local Authorities and a very careful assessment having been made by the staff in the drawing office of the population served by the Company in the several Council Areas. The average estimated number of persons per house for the Company's area as a whole is 3.1. This is considered to be a reasonable figure in keeping with the returns of the Registrar General for this area. In relation to those parts of the Borough at Worcester Park and on the St. Helier Estate at the northern end of the former Carshalton Urban District Council's area, Dr. E. Windle Taylor, Director of Water Examination to the Metropolitan Water Board, has supplied the following informations:- (a) The supply was satisfactory both as to quality and quantity throughout 1968 and 1969. (b) All new and repaired mains are disinfected with chlorine. After a predetermined period of contact the pipes are flushed out and refilled. Samples of water are then collected from these treated mains, and the mains are returned to service only after results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, from the treatment works or well stations, from the distribution system, and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. (c) (i) The Board has no record of the number of structurally separate dwellings supplied in the area, but the population supplied direct, according to the Registrar General's estimates at 30th June 1969 was 19l8. (ii) No houses were permanently supplied by standpipe. (d) No artificial fluoride was added and where the fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. (e) The supply was derived from the following works and pumping stations:- River Thames derived and also well water from Merton Pumping Station. No new sources of supply were instituted and there were no changes to the general scheme of supply in the area. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown as follows:- - 117 - Bacteriological ResultsYearly Averages, After Treatment Number of Samples Agar plate count per ml. Coliform count E, coli count 20-24 hours at 37°C. 3 days at 22° C. Per cent samples negative in 100 ml. Per cent samples negative in 100 ml. Thames derived 1968 1931 10.8 - 99.79 100.0 Thames derived 1969 3698 12.9 - 99.89 100.0 Merton 1969 19 0.2 2 100.0 100.0 Average Results of the Chemical Examination of Water (Milligrammes per litre (unless otherwise stated) 1968 1969 1969 1968 1969 Thames Thames Merton Thames Thames Merton No. of Samples 156 371 4 Chloride as C1 33 32 13 Ammoniacal Nitrogen 0.023 0.024 0.005 Phosphate as PO4 2.0 2.1 - Albuminoid Nitrogen 0.081 0.083 0.017 Silicate as Si02 10 9 - Nitrate Nitrogen 4.0 4.4 0.2 Sulphate as SO4 62 58 - Oxygen abs. from KMnO4 1.22 1.05 0.08 Natural Fluoride as F 0.30 0.25 0.50 Hardness(total) CaCO3 271 282 252 Surface-active material as Manoxol OT 0.02 0.02 - Hardness (Non- carbonate) CaCO3 73 79 38 Turbidity Units 0.1 0.1 0.4 Colour (Burgess units) 14 11 4 Magnesium as Mg 4 5 - pH value 7.9 7.9 7.4 Sodium as Na 22.9 24.0 - Electrical Conductivity (mircomhos) 560 550 430 Potassium as K 5.3 5.4 — - 118 - On account of their hardness content and alkaline reaction the Board's river and well water supplies are not considered to be plumbo-solvent. It should, however, be appreciated that all types of water pick up varying amounts of metal from the material of water piping particularly when it is newly installed., This applies to copper, zinc, iron and also to lead. Special tests for lead have been carried out during 1968 on 100 premises where a lead supply pipe is installed. The premises were chosen to give an even distribution of samples throughout the whole of the Board's area. Two samples were collected from each premises. One was the first running of water standing in the lead pipe overnight and the other was a sample of water after running the tap for a few minutes. Lead content of water from main taps in consumers' premises Lead content (mg/l Pb) Samples of water standing in lead pipe overnight Samples of water after running the tap Less than 0.01 10 37 o.o1 31 57 0.02 21 4 0.03 8 1 0.04 9 0 0.05 5 0 0.06 5 0 0.07 4 1 0.08 1 0 0.09 3 0 0.10 1 0 0.l2 1 0 0.16 1 0 100 premises 100 premises These results are very satisfactory and the figures are within the limits of the World Health Organisation European Standards for Drinking Water Quality. This states that the upper limit for lead in running water in the supply should not be more than 0.1 mg/l (Pb), but where water undertakings continue to use lead piping the concentration of lead (as Pb) should not exceed 0.3 mg/l after l6 hours contact with the pipes. - 119 - PREVENTION OF DAMAGE BY PESTS ACT 1968 1969 Complaints of rat and mouse infestation 1665 1631 Infestations investigated 1665 1631 Premises found to be infested 1684 1660 Informal Notices under Section 4 of the Act 13 14 NOISE ABATEMENT Complaints received 55 77 Informal action was taken in appropriate cases to reduce the noise level. SHOPS There were 1,741 shop premises in 1968 on the register and 1,674 in 1969 and inspections were made during the year under the Shops Act 1950 and the Offices, Shops and Railway Premises Act 1963. OFFICES. SHOPS AND RAILWAY PREMISES ACT 1963 During 1968, 23 and 1969, 82 premises were registered in accordance with the Act, making the total number 1,762. The number of persons employed in the classes of premises as reported to the Minister of Labour at the end of the year is as follows:- Class of premises Total Number Registered at end of Year Number of Persons Employed 1969 1968 1969 1968 Offices 525 491 6470 6673 Retail Shops 1106 1068 5231 6054 Wholesale Shops, Warehouses 34 30 351 300 Catering Establishments and Canteens 95 89 736 784 Fuel Storage Depots 2 2 20 20 - 120 - Preliminary notices were served relating to non-compliance with the Act in respect of the following:- Notices Served during 1968 1969 Complied (Inc. Notices served in 1967) 1968 1969 Overcrowding - 1 2 2 Ventilation 4 5 12 2 Cleanliness 8 9 18 3 Temperature (incl. thermometers) 32 30 92 20 Lighting 10 6 18 5 Sanitary Conveniences 33 33 46 9 Washing Facilities 29 22 37 12 Water Supply 7 16 16 4 General Conditions 18 7 10 2 Stairs/Passages 7 1 14 4 Clothing Storage 9 9 17 4 Drying Facilities 5 3 19 3 Seats - - 4 l Machinery 1 - 1 - First Aid Equipment 34 43 93 17 Notices 49 62 110 33 Canteen Facilities 2 - 4 1 Factories and Outworkers. Inspections for the purpose of provisions as to health:- Premises No. on Register Number of- Inspections Written Notices Occupiers Prosecuted (1) (2) (3) (4) (5) 1968 1969 1968 1969 1968 1969 1968 1969 (i) Factories in which Sections 1, 2, 3, 4 & 6 are to be enforced by Local Authorities 48 48 16 21 - - - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 539 539 156 147 38 8 - - (iii) Other premises in which Section 7 is enforced by the Local Authority 4l 41 82 27 - - - - * (excluding outworkers' premises) 254 195 38 8 — - * Electrical Station (Section 123 (1) ), Institutions (Section 124) and sites of Building Operations and Works of Engineering Construction (Section 127). Slaughterhouses, (Section 175 (l) (d) and (e) )and Railway Running Sheds (Section 175 (2) and (10)). - 121 - Cases in which Defects ware Found: Premises Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred- to H.M. Inspector by H.M. Inspector (1) (2) (3) (4) (5) (6) '68 '69 '68 '69 '68 '69 '68 '69 '68 '69 Want of cleanliness - 19 - 17 - - - - - - Overcrowding - - - - - - - - - - Unreasonable temperature - - - - - - - - - - Inadequate ventilation 2 l 1 9 - - - - - - Ineffective drainage of floors — — — 1 — — — - - - Sanitary Conveniences: (a) Insufficient - 2 - 5 - - - - - - (b) Unsuitable or defective 4 10 2 14 - - - - - - (c) Not separate for sexes - 1 - 1 - - - - - - Other offences against the Act (not including offences relating to Outwork) 2 2 1 4 - - - - - - Outwork (sections 133 and 134) Nature of Works Section 133 Section 134 No. of outworkers in Aug. list required by Sect. 133(1)(c) No. of cases of default in sending lists to the Council No, of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) 69 68 69 68 69 68 69 68 69 68 69 68 Wearing apparelmaking etc. 67 28 - - - - - - - - - - Boxes (Cardboard) 53 28 - - - - - - - - - - Brass and Brass Art 1 2 - - - - - - - - - - Curtain making 3 - - - - - - - - - - - Toys 1 - - - - - - - - - - - Flowers 2 - - - - - - - - - - - Umbrellas 9 - - - - - - - - - - - Lampshades 21 3 - - - - - - - - - - 157 63 - - - - - - - - - - - 122 - SWIMMING BATHS Visits were made to the three public swimming baths and five school pools during the period. Twenty-nine samples in 1968 and 19 samples in 1969 of water were submitted for bacteriological examination. Checks for pH value and free chlorine were made in appropriate cases. The close co-operation which exists between the Borough Engineer, the Chief Education Officer and this Department is much appreciated. HAIRDRESSERS AND BARBERS The Council adopted on the 4th April, 1968, the provisions of the Greater London Council (General Powers) Act 1967 in so far as they relate to the registration of Hairdresser and Barbers, and fixed the first day of June, 1968, as the appointed day for the purpose of registration in accordance with Section 21 of the Acta By the end of 1969 135 premises were registered following inspections to ensure compliance with bye-laws requirements. MORTUARIES The Council maintains a mortuary at Cemetary Road, Sutton Common Road, Sutton, which is equipped with refrigeration storage and facilities for postmortem examination. The number of bodies, on all of which autopsies were performed, admitted during the year was as follows:- 1968 1969 Ambulance removals 66 107 From local hospitals 173 174 From homes within the Borough 271 209 510 490 PUBLIC CONTROL Work connected with Licensing, Permits and Registrations was transferred from the Department of the Town Clerk to the Health and Family Services Department on the 1st July, 1968. The following is a list of Licences, Permits and Registrations in force at 31st December, 1968 and 1969:- 1968 1969 Betting, Gaming and Lotteries Acts 1963/64 Small Lotteries-Registrations 117 123 Amusement Machines with Prizes-Permits 82 97 Animal Boarding Establishments Act 1958. Licences 6 5 Diseases of Animals (Waste Foods) Order 1957. Licences 18 18 London Government Act 1963. Employment Agency Licences 12 18 Surrey County Council Act 1931 (Part IV) Establishments for Massage & Special Treatment. Licences 18 19 Game Act 1831. Game Dealers' Licences 21 19 Greater London Council (General Powers) Act 1967 Hairdressers and Barbers Registrations 132 135 Moneylenders Act 1927-Licences 3 3 - 123 - 1968 1969 Pharmacy and Poisons Act 1933 Sellers of Part II Poisons. Registrations 152 130 Pet Animals Act 1951. Licences l6 15 Rag Flock and Other Filling Materials Act 1951 Registrations 4 4 Refreshment Houses Acts 1860 and 1967. licences 7 7 Riding Establishments Act 1964. Licences 2 2 Theatrical Employers Registration Acts 1925 and 1928 Licences 35 37 Scrap Metal Dealers Act 1964. Registrations l6 15 Slaughter of Animals Act 1958. Licence 1 1 OTHER MATTERS Diseases of Animals Act 1950. Functions of the Council in connection with the Diseases of Animals Act 1950, Animal Boarding Establishments Act 1963, Pet Animals Act 1951, and the Riding Establishments Act 1964 are carried out on an agency basis by the Council of the City of London through that Council's Veterinary Officer. Rag Flock and Other Filling Materials Act 1951 The prescribed Analyst is Mr. Derek James Finch, LTI of RTSA (Chiltern Research), West-field House, Henley on Thames, Oxfordshire. Six samples taken during the period satisfied the requirements. Fertilisers and Feeding Stuffs. Two informal samples of Feeding Stuffs and six informal samples of Fertilisers were taken during 1968 and two informal samples were taken in 1969. All the Public Health Inspectors of the Borough have been approved by the Ministry of Agriculture, Fisheries and Food as Inspectors and Official Samplers under the Fertilisers and Feeding Stuffs Act 1926. Radioactive Substances Act 1960. The following are firms within the district to whom Certificates of Registration or Certificates of Authorisation for the disposal and accumulation of radioactive waste have been issued by the Ministry of Housing and Local Government under the Acts:- Section 1. (Registration-Keeping and use of Radioactive Material): London Fire Brigade, Sutton and Wallington Stations. Medical Research Council, Woodmansterne Road, Carshalton. Mr. M. Milian, 44A Sherwood Park Road, Sutton. Mullard Radio Valve Co., New Road, Mitcham Junction. Nuleaf Ltd., Beddington Lane, Croydon. Pye Unican Ltd. 30 Devonshire Road, Sutton. Vinyl Products Ltd., Mill Lane, Carshalton. - 124 - Section 3. (Registration-Mobile Radioactive Apparatus): Inspection Services Ltd., Oldfields Road, Sutton. Radiographic and Associated Testing Services, 43 Senga Road, Hackbridge. Section 6/7. (Authorisation-Disposal and Accumulation of Radiactive Waste): Radiological Protection Service, Clifton Avenue, Belmont. Royal Marsden Hospital, and the Institute of Cancer Research, Downs Road, Belmont. SUMMARY OF COMPLAINTS, INSPECTIONS AND WORK DONE Investigations were made with regard to 6,192 complaints, as follows:- 1968 1969 Accumulations 71 66 Animals so kept etc. 4 6 Burst pipes 2 2 Clean Air-Contraventions 91 41 Dampness 136 127 Drainage defects 83 82 Drains obstructed 2,015 2,035 Dustbins 6 8 Factories Act l - Food contaminated 89 92 Food unsound 77 96 Fouling of Footpaths 9 30 General Defective Conditions 61 69 Insects and Pests 497 809 Litter Act Contraventions 2 - Miscellaneous 110 116 Noise 55 77 Obnoxious Effluvia 92 111 Overcrowding 2 8 Public Conveniences 1 6 Refuse Collection 14 695 Rivers 4 6 Rodents 1,665 1,631 Roofs defective 29 15 Shops Act contraventions 4 5 Sink Waste Pipes 2 7 Verminous premises 1 48 Water Supply 16 4 5,139 6,192 Seventeen thousand, eight hundred and five inspections and re-inspections were made for the purposes set out below:- 1968 1969 Animal Boarding Establishments 3 9 Clean Air Act 652 622 Consumer Protection Act - 1 Cowsheds 1 - Diseases of Animals Act - 60 Employment Agencies 7 8 Establishments for Massage & Special Treatment l4 31 - 125 - 1968 1969 Factories (Mechanical Power-incl. Laundries) 156 147 Factories (non-Mechanical Power) l6 21 Factories (Building Sites) 82 27 Fertilisers and Feeding Stuffs 5 4 Food and Drugs (incl. Sampling, Unsound Food etc.) 1,273 1,260 Food Premises: 1968 1969 Bakehouses 74 55 Bakers & Confectioners 71 64 Butchers 316 250 Canteens ll8 104 Canteens-Schools 60 26 Chemists 7 14 Confectioners (Sugar) 134 107 Factory Food l6 10 Fishmongers 112 75 General Stores 129 128 Greengrocers & Fruiterers 250 324 Grocers 398 324 Ice-Cream Factories 3 2 Ice-Cream Vehicles 17 25 Licensed Premises with Catering Facilities 67 55 Licensed Premises without Catering Facilities 67 38 Milk Storage Depots 42 l4 Restaurants and Cafes 376 358 Stalls, Food 297 36 Vehicles, Food 104 126 2,658 2,135 Hairdressers 197 53 Housing Act 982 1,101 Housing (Land Charges Enquiries) 39 80 Infectious Disease Premises (Incl. food poisoning enquiries) 511 825 Insect Pests 588 511 Merchandise Marks Act 19 73 Noise 227 521 Offices, Shops and Railway Premises Act l,l6l 902 Outworkers Premises 4 55 Pet Animals Act 6 13 Pharmacy and Poisons Act 6 28 Piggeries 5 5 Premises re cesspools - 2 Public conveniences 170 176 Public Health Act 6,973 6,612 Public Health Act re-inspections 2,031 1,342 Rag, Flock and Other Filling Materials Act 3 4 Rent Act 23 l6 Riding Establishments Act l6 3 Rivers, Ditches and Ponds 27 79 - 126 - 1968 1969 Rodents 959 663 Schools 15 21 Shops 231 395 Water sampling 82 50 Work Places 28 20 19,170 17,875 Six hundred and fifty three notices were served concerning the following matters:- 1968 1969 Accumulations and Deposits 11 19 Animals so kept 1 6 Clean Air Act 9 3 Drainage Defects 107 60 Dustbins 3 10 Factories Act 8 40 Food and Drugs Act (incl. Food Hygiene) 162 122 General Defective Conditions 285 190 Housing Act (unfit houses) 51 36 Noise 5 5 Offices, Shops and Railway Premises Act 131 116 Prevention of Damage by Pests Act 13 14 Shops Act 4 32 Water Supply 3 — 773 653 Formal notices were served under the following Acts:- 1968 1969 Public Health Act 1936, Section 24 42 23 „ „ „ Section 39 7 3 „ „ „ „ 45 2 1 „ „ „ „ 56 1 - „ „ „ „ 93 17 22 „ „ „ „ 277 2 8 Housing Act 1957, Section 170 8 6 „ „ 1961 „ 15 3 1 Clean Air Act 1956, Section 12 3 — 85 64 - 127 - As a result of investigations made and notices served, the following work was carried out:- 1968 1969 Accumulations removed 19 20 Brickwork repaired 8 - Ceilings repaired and/or made good 14 9 Chimneys and flues repaired 6 5 Damp conditions remedied 62 40 Doors and frames repaired, including locks and fasteners 7 5 Drainage repaired and/or reconstructed (houses) 29 23 Drainage inspection chambers repaired 20 18 Soil pipes renewed 6 3 Drains cleared 1,634 1,803 Waste gullies repaired, renewed or provided 16 9 Waste pipes repaired, renewed or provided 8 6 Surface water drainage provided or repaired 8 4 Dustbins provided 4 3 Fireplaces, ranges or stoves repaired or renewed 7 2 Floors renewed or replaced 20 10 Food Storage accommodation provided 3 - Roofs repaired and made weatherproof 38 24 Downpipes, guttering repaired and/or renewed 44 28 Stairs repaired 6 1 Sinks renewed 2 - Walls repaired 10 7 re-plastered and/or repaired 29 15 Cleansed and redecorated 6 5 Wash basins and baths provided 1 - Water supply renewals or repairs 12 3 W.C. provided - 1 W.C. accommodation repaired 6 1 W.C. pans and seats repaired, renewed or provided 13 5 flushing apparatus repaired or renewed 21 8 Windows repaired and/or renewed 36 15 Ventilation provided 8 3 - 128 - SOCIAL SERVICES DIVISION PART IV (NATIONAL ASSISTANCE ACTS) INDEX Page No INTRODUCTION 130 A CASEWORK AGENCY 130 THE CHILDREN'S SERVICE 130 THE WELFARE SERVICE 130 SERVICES FOR THE ELDERLY 133 SERVICES FOR THE PHYSICALLY HANDICAPPED 134 CARE OF THE BLIND AND PARTIALLY SIGHTED 137 W. France, ACCS AISW, Chief Social Services Officer. -129- INTRODUCTION Amidst all the traditional welfare work carried on in the period under review came the creation of a Social Services Division as part of a larger directoratethat of Health & Family Services-controlling Housing, Health, Welfare, and Children's Departments. This latter event overshadowed all else and resulted in a number of officers leaving the social services, bringing with it the difficulties of replacement and in some instances reallocation of work. But it also brought the appointment of an additional senior child care officer, a senior family caseworker and a casework co-ordinator, and for the first time it became possible to pull together the whole of the casework effort of the social services. During this period of resignation and recruitment, so much was said and written that one could be forgiven for forgetting the very raison d'etre for the social services; fortunately the task of caring goes inexorably on as the statistics which follow in the report to some extent show. A CASEWORK AGENCY The appointment of the senior staff referred to in the Introduction allowed us to undertake regular consultation with professional social welfare staff and gave administrative control over case loads of all the social workers; the senior family caseworker with her team of four intensive family caseworkers has become responsible for those families in the borough with a multiplicity of problems and for whom it is thought that casework support will be beneficial. In this way child care officers have been helped by a reduction in case loads, and social welfare officers in the Division to some extent relieved of work with families requiring intensive casework support. It has also become possible to bring to bear all the resources of the directorate in support of those families amongst us at risk of losing their homes. At the time of writing there are over 100 families in the borough facing the threat of losing their accommodation, mostly for reason of rent arrears, and perhaps it is in this context if in no other that we should look at the reorganisation of social services in the borough, and at the creation of a highly skilled and professional intensive family casework unit offering casework support. Here let me say that the authority delegated to the Director of Health & Family Services to rehouse deprived families on their immediately becoming homeless, as a matter of social priority, is the biggest single benefit accruing from the reorganisation. It is one thing to speak of co-ordination, quite another to achieve it. It is as much in the hearts and minds of men as it is in any administrative scheme. Case conferences and casework co-ordination have been made considerably easier, and all social workers now operating in the four area geographical social work teams obviously find it simpler to discuss with each other their cases and problems common to them. Of course we do not always win in the sense that social workers have a magic wand which, on its being waved, changes the characters and inhibitions of a lifetime in their clients and administers instant justice. But if there is no winning (with our families) in the ordinary sense of the word, and if by contrast I might use the word failure and the consequences of it, then unless we continue to try harder the progression of our families down the slope of despair, demoralisation and ultimate defeat will be assured. THE CHILDREN'S SERVICE As to the Children's Service during the period under review, probably the appointment Of the additional senior child care officers was the most significant factor allowing as it did for the first time regular consultation and control over child care officers case loads. Fortnightly reviews of all cases with child care officers have continued, allowing the concentration of their work on cases of the highest priority. -130- The effect of this is that for much of the period under review case loads have been constant at about the 60 mark for each officer,. Periodic meetings with a consultant psychiatrist from the Child Guidance Clinic at St. Helier Hospital have continued, and have proved to be of great value both to residential care staff and to field staff. As with all the other social work disciplines in the Division, considerable use has been made of courses run by the London Boroughs Training Committee and the Home Office Central Training Council,care being taken that courses attended were of particular value to the officer in his field of work. But a significant development in training was the setting-up by four neighbouring London boroughs of an intensive training scheme for houseparents, based at Ewell Technical College and The Grove, Carshalton. This authority played an active part in the organisation of these courses. The Working Girls Hostel 'Silverdale' was opened during the year. This was formerly a hostel for district nurses and was easily adapted for 8 working girls in care, either of this or other local authorities. This hostel meets a real need as a preventive measure enabling the Children's Service to give the girls a period of care and training in the locality of the borough and in a supportive environment. The greatest challenge awaits the Children's Service with the placing on the statute book of the Children and Young Persons Act of 1969. This places further responsibilities on local authority services and will inevitably require the recruitment of a further number of child care officers to accept the additional referrals of children under supervision from the courts and other Agencies. It is confidently expected that with the return from training courses upon which they are currently engaged, professionally qualified child care officers of the Department will be in a position to pick up this responsibility as arising; this, however, is only one aspect and the department is well aware of the tasks to be faced. THE WELFARE SERVICES I would like to say how pleased I am to report the increasing use made during the period under review of our group of old people's homes for shorter term care. In this way, relatives of old people often hard pressed in the demanding routine (however lovingly given) of caring for elderly relatives, are relieved by their admission to one of our old people's homes whilst the family takes a break. During the period under review some 60 old people had 'holidays' with us for short periods, whilst relatives besported themselves elsewhere to the benefit of all. We look forward to the opening of Bawtree House in Worcester Road, in early 1970, further to increase the number of places available to us to care for old people. It is worthwhile noting that in the year ended December 1968, of the 185 admissions during the year, 58 were between the ages of 70 and 80, 76 were between the ages of $0 and 90, and 18 were between the ages of 90 and 100; the year 1970 tells a similar story. And the work of our Mulgrave Road centre for the physically disabled goes from strength to strength. All the daily A-5 places are now taken up and there is a waiting list. In all, the centre serves about 120 disabled people, and whilst it can be argued that at a maximum of per day the centre is not really meeting the total need of the borough, it is, nevertheless, much valued by those fortunate enough to attend there. It seems that no task is too difficult or complex for this happy band, and whilst it is true that remuneration is not the only object of the work centre, our disabled people do receive a little money reward for taking part in the industrial outwork schemes. -131- There are other things also-musical appreciation groups, craft classes, archery classes, current affairs discussions, and so on-all helping our disabled people to belong to the mainstream of life. As is the case with the Children's Service, so the traditional welfare services face a challenging situation. The Chronically Sick and Disabled Persons Bill of 1970, placing far reaching duties on local authorities in the care of disabled, and those parts of the Health Service and Public Health Act of 1968 which come into force in 1970, placing a duty upon local authorities actively to promote the welfare of old people in the borough, again poses the need for additional recruitment of welfare officers to implement the new duties. CONCLUSION For so long, social work has struggled under the yoke of being a profession of many disciplines, this or that sort of officer, or the other brand of social worker, all tending to present to the public at large a picture of a fragmented service, incapable of cohesive effort and lacking in all-embracing leadership; unable to deploy the available resources in a realistic way, and utterly diffident in encouraging all social workers towards an awareness of each others problems and of the one-ness of the effort we are all making. Happily, in the Social Services Division in Sutton, we have taken some steps, albeit falteringly at times, towards the departmental structure advocated by the report of the Seebohm Committee and legislated by the Local Authority and Social Services Act of 1970. We are making progress. -132- SERVICES FOR THE ELDERLY The main event in the 2 year period under review was the opening of Franklin House on the 17th February, 1969, the purpose-built old people's home at Roundshaw. This home offers 50 places for men and women and has quickly established itself as part of the community. Borough Residential Old People's Homes 1968 1969 Waiting list at beginning of year 129 153 Waiting list at end of year 153 125 Number of beds available; Brambleacres 43 43 Maiden Homes 112 112 St. Anne's Redhill 30 30 Franklin House 50 185 235 Bawtree House (48 beds) newly built old people's home in the grounds of 'Brambleacres', Worcester Road, Sutton, will be available to the department in May 1970, thus increasing the number of beds for old people to 283. Standard Charges for Accommodation The standard rate of maintenance in old people's homes administered by the Borough for the year ended 31st March, 1968, was £11 19s 9d. per week, and at 31st March, 1969, was £13 15s lld. Accommodation provided by the Voluntary Old People's Homes As well as those homes provided by the Borough, there is a small group of homes (now 6 in number) owned and administered by voluntary organisations,, These homes provide accommodation for old people and offer a further choice to those of a particular sect or religious pursuasion to enter into their own particular residential care unite Financial arrangements exist with these homes which allows the authority to meet the maintenance charges where such a course is appropriate. Registration of Private Old People's Homes The local authority has a duty to register and inspect homes run for profit by private individuals or companies, and there are now in the Borough 25 registered private old people's homes, offering accommodation for 326 old and/or disabled people. Two homes registered under the Mental Health Act of 1959 afford accommodation to 34/37 people recovering from mental illness. Meals and recreation for the elderly The close co-operation between the department and the three main old people's voluntary welfare committees has been maintained and the number of meals-onwheels distributed and served has grown. The opening on l8th November, 1968 of the new Day Centre of the South Carshalton Old People's Enterprises (SCOPE) has been one of the highlights and this is a welcome addition to the day centre already operating on the Brighton Road. Other day centres are being planned in the Borough-the most noteworthy of these being the one planned in the Worcester Park/Cheam area by voluntary bodies and the fourth being planned by the Borough as an adjunct to their old people's home programmed to be built on the Alcester Road, Wallington site, in the future. -133- 58,260 meals were served during the year 1968 to the housebound. 61,996 meals were served during the year 1969 to the housebound. TEMPORARY ACCOMMODATION-HOMELESS FAMILIES. Under its welfare powers the Borough is required to offer temporary accommodation to all families who are homeless from whatever reason and support them in practical and social work terms towards their eventual resettlement in the community. It was the original intention of the 1948 statute to apply this provision only to families dispossessed as a result of fire, flood, and similar catastrophe which 'could not reasonably have been foreseen'. But the passage of years has wrought a change. Public opinion, and government circulars, have made it clear that when a family has nowhere to go the local authority must provide. In the period under review, the department has three main communal units for families-'Ladymount', Evelyn Way, Wallington and Nos, 23 and 25 Cheam Road, Sutton, One of the earlier residential units, 'Oakdene', in Denmark Gardens, Carshalton disappeared under the bulldozer during the year to make way for the further development of the site upon which it stood. There were no regrets at its passing; the building was in poor condition and difficult to maintain both for the local authority and families alike. Four council houses were allocated to the department for use as long-term rehabilitation units for families with many problems, and some 8 other properties owned by the Ministry of Transport are now on lease to the department and used for families previously without homes whose difficulties may take some years to settle, WELFARE SERVICES FOR THE PHYSICALLY HANDICAPPED (GENERAL CLASSES) Local authorities are required to keep a register under Sections 29 and 30 of the National Assistance Act of 1948, and the following statistics show the grouping of disabilities and the register in accordance with the Medical Research Council code of diseases and disability. The number of registrations during the year 1968 was 221, bringing the total number of registered disabled people to 1,023; during 1969 the number of registrations was 114, total number of registered physically disabled people 1082, Section 29 of the National Assistance Act, 1948 imposes a duty to provide Welfare Services for the handicapped (general classes) and the deaf and hard of hearing. These duties may be defined as follows:- (a) Informing handicapped persons of the services available to them (b) Giving instruction in their homes or elsewhere in methods of overcoming the effects of their disabilities (c) Providing workshops where such persons may be engaged in suitable work, and hostels where persons engaged in the workshops may live (d) Providing handicapped persons with suitable work in their own homes or elsewhere (e) Helping handicapped persons to dispose of the product of their work (f) Providing handicapped persons with recreational facilities in their own homes or elsewhere (g) Compiling and maintaining registers of handicapped persons. - -134- As to the manner in which handicapped people have either voluntarily come forward or been referred for registration is demonstrateds:— No. of handicapped people on the register 31.12.68 1023 No. of removals and deaths 135 No. of newly registered handicapped persons 194 No. of handicapped persons on register at 31.l2.69 1082 and the extract of statistics from the statutory register shows the following classifications Classification of Disabilities and Age Groups Under 16 16-29 30-49 50-64 65+ Total at 31.12.69 Total at 31.12.68 Amputation _ 2 3 17 21 43 45 Arthritis 1 2 21 77 282 383 351 Congenital Malformations 4 8 6 2 1 21 18 Digestive and Heart _ 4 6 41 78 129 132 Injuries 1 4 9 18 46 78 71 Organic ND 10 47 83 120 97 360 342 Neurosis _ 2 3 6 3 14 13 T.B. Resp. _ _ 1 4 4 9 10 T.B. Surg. _ _ 2 3 5 10 12 Any other _ 3 1 9 23 35 29 16 72 137 297 560 1082 1023 Deaf Deaf with Speech 3 11 12 1 7 34 33 Deaf without Speech l 4 9 5 7 26 25 Hard of Hearing _ 4 3 6 47 60 59 4 19 24 12 61 120 117 -135- Employment and facilities for work for the disabled So far as employment is concerned, the 1082 registered handicapped persons fall into the following groups:- l. Capable of normal employment 115 2. Capable of sheltered employment in accordance with definition of the Min. of Labour 37 3. Capable of some work or part time work in very sheltered conditions (e.g. Work Centre) 103 (a) Attendance at Work Centre 79 (b) Receiving outwork and/or occupational therapy 40 4. Available as home workers Not Known 5. Not available for work 806 6. Under l6 years of age 21 Visits made by Social Welfare Officers from 1st January 1969 to 51st December 1969 Visits made in connection with handicapped social work and registration 1872 Visits made in connection with escort duties to and from the work Centre 187 Visits made in connection with adaptations 249 Visits made in connection with outwork 2 Visits made in connection with occupational therapy 776 Visits made in connection with occupational therapy at Brambleacres 54 Visits made in connection with occupational therapy at Maiden Homes 47 Aids to daily living; Number of aids issued on loan during the year 1969 396 Adaptations; Adaptations have been carried out in the homes of 56 handicapped persons during the year at an approximate cost of £1,860. Transport The three ambulances have been kept fully occupied during the year, they are regularly used for the transport of handicapped persons to the Red Cross Clubs, the Invicta Club, the British Polio Fellowship Club meetings, the British Rheumatism and Arthritis Club meetings, the Rotary Club of Sutton Film Show evenings and the Spastic Centre at Croydon daily. The ambulances of course serve the Work Centre daily, the holiday scheme and such voluntary organisations as it is possible to assist during the year. Part time clubs for the disabled The Red Cross Society continues to operate four clubs for the disabled in the Borough. n-i cabled Drivers In accordance with the Ministry regulaticins, disabled drivers windscreen badges have been issued by this department as follows No. of badges issued at 31.12.68 100 No. of removals since 31.12.68 3 No. of new badges issued since 31.12.68 29 Total No. of car badges issued at 31.12.69 126 -136- Holidays for the handicapped After circulating all registered handicapped persons, the final holiday arrangements for 1969/70 were as indicated below Centre Handicapped Persons Blind Persons Escorts Hayling Island 37 8 5 Lulworth Court 3 _ _ Grange Farm 2 _ _ Crabhill House 1 _ _ Total number of persons and relatives to be assisted with holidays 88. Estimated cost to the Borough of this project in the year under review £1,940. The sum of £1,800 (gross) is included in revenue estimates for 1970/71 for the holiday scheme against which provision is made for an estimated income of £800. A booking has been made for September 19th - October 3rd 1970 at the Sunshine Holiday Camp, Hayling Island, for 50 handicapped persons and blind persons, relatives and escorts. Bookings are also being made at Lulworth Court and other such establishments. Handicapped people are helped with individual holiday arrangements where the need is justified. WELFARE OF THE BLIND AND PARTIALLY SIGHTED As in previous years the annual return submitted to the Ministry of Health on the 31st December each year has been taken as a basis of appraisal of the work of the department in relation to the blind and partially-sighted. The total number of registered persons:- At 31.12.1968 BLIND 353 PARTIALLY SIGHTED 97 At 31.12.1969 BLIND 378 PARTIALLY SIGHTED 97 The corresponding figures at 31.12.1967 were:- BLIND 35O PARTIALLY SIGHTED 80 giving a net increase over a two year period of 45. Age period of Registered Blind and Partially-sighted person. YEAR 1968 BLIND PARTIALLY SIGHTED 0-4 5-13 16-49 50-64 65+ TOTAL. 0-4 5-15 16-49 50-64 65+ TOTAL. Hales 1 2 17 23 87 130 1 4 11 6 17 39 Females _ 1 12 33 177 223 _ 4 11 4 39 58 Total at 31.12.68 1 3 29 56 264 353 1 7 22 10 56 97 -137- YEAR 1969 BLIND PARTIALLY SIGHTED 0-4 5-15 16-49 50-64 65+ TOTAL. 0-4 5-15 16-49 50-64 65+ TOTAL. Males _ 3 17 22 97 139 _ 6 17 6 16 45 Females 1 1 15 29 193 239 _ 3 11 2 36 52 Total at 31ol2.69 1 4 32 51 290 378 _ 9 28 8 52 97 In 1968, 48 of the total of 353 blind persons had other defects e.g. four have multiple defects in addition to that of blindness (a combination of physical disabilities including deafness)l6 were physically handicapped, eight mentally defective or disordered, five deaf with speech, 14 hard of hearing and one deaf without speech. In the year 1969, of the 378 blind persons, 47 have other defects, 14 are physically handicapped, nine mentally defective or disordered, six deaf with speech, 13 hard of hearing and one deaf without speech. Notifications of suspected blindness received in the course of the period under review for whom examinations were arranged with Consultant Opthalmologist yielded the following results:- Notification from: TOTAL Certified BLIND Certified P/S Found not to be Blind or P/S Re-exams 1968 1969 1968 1969 1968 1969 1968 1969 1968 1969 Ministry of Social Security 6 9 5 7 _ 1 1 1 Relative, individual enquiries 16 8 7 4 4 _ 5 4 Social. Welfare Officers 10 8 8 3 _ 5 2 _ General Practitioners 1 3 _ 2 _ _ 1 1 Hospitals (B.D.8's direct) 32 26 20 19 12 6 _ 1 Voluntary Agencies 6 2 2 2 2 _ 2 _ District Nurses/Health Visitors 3 3 2 2 1 l _ _ Re-examinations 10 12 10 12 -138- Movement on Blind and Partially-sighted Registers BLIND REGISTER Total number of cases on register 31.12.1967 51.12.1968 51.12,1969 350 353 378 During the period under review there were 1968 1969 ADDITIONS As a result of ophthalmic examinations 44 39 Partially-sighted persons found to be BLIND on re-examination 4 6 Persons moving into Borough 15 16 63 6l DEDUCTIONS Blind persons deceased 48 26 Blind persons removed from Borough 12 10 60 36 Giving an increase of 3 25 PARTIALLY SIGHTED REGISTER Total number of cases on register 51.12.1967 51.12.1968 51.12.1969 80 97 97 During the period under review there were ADDITIONS 1968 1969 As a result of ophthalmic examinations 19 13 Persons moving into Borough 8 8 27 21 DEDUCTIONS Partially-sighted persons deceased 3 8 " " " removed from Borough. 3 7 " " " Transferred to Blind Register (sight deteriorated) 4 6 10 21 Giving an increase of 12 Nil Total number of cases on register 97 97 -139- Education, Training and Employment of Blind and Partially-sighted Persons. BLIND Children receiving education EMPLOYED Open Industry In Workshops (Sheltered) Homeworkers Scheme NOT EMPLOYED Incapable of work/education Not available for work TOTAL 1968 1969 1968 1969 1968 1969 1968 1969 1968 1969 1968 1969 1968 1969 Males 2 2 19 19 1 1 4 4 10 7 94 106 130 139 Females 1 1 4 7 _ _ 2 2 10 10 206 219 223 239 TOTAL 3 3 23 26 1 1 6 6 20 17 300 323 353 378 PARTIALLY SIGHTED Males 4 6 13 17 _ _ _ _ _ _ 22 22 39 45 Females 4 3 6 6 _ _ _ _ _ _ 48 43 58 52 TOTAL 8 9 19 23 _ _ _ _ _ _ 70 65 97 97 The foregoing table indicates the work done in the education and employment of the blind and partially-sighted, and gives some indication of the variety of occupations carried out in open and sheltered employment; a detailed list of occupations is given:- BLIND Homeworkers No, Occupation No. Occupation No. Occupation 1 Basket Maker 1 Piano Teacher 2 Physiotherapists 1 Chair Caner 1 Teacher of Dancing TOTAL 6. Workshop Employee 1 Operative in Soap Factory TOTAL 1. Employed in open industry 1 Physiotherapist 1 Consultant (Eng) 1 Kiosk Manager 1 Social Welfare Officer for the Blind. 6 Assemblers 1 Builder (own business) k Factory operators 2 Shorthand Typists 2 Shopkeepers 1 Packer 2 Telephone Operators 1 Storekeeper 1 Carpenter 2 Typists TOTAL 26. PARTIALLY SIGHTED Employed in open industry 2 Cleaners 1 Laundry-hand 1 Nursery-gardener 2 Telephone Operators 7 Factory operatives 2 Clerical workers 1 Master Builder 1 Electrician 1 Pastry-hand 1 Physiotherapist 1 Kiosk Manager 1 Receptionist 2 Packers TOTAL 23. -140- Home Teaching- Visiting and Advisory Service 1968 1969 Total number of visits made to blind and partially- sighted persons during:- 1439 1646 Lessons given in Braille, Moon or Craft-work 409 351 The fortnightly Handicraft Class held at Highfield Hall, Carshalton was well attended and undoubtedly fills a great need. More transport service would enable greater numbers of housebound blind to attend,. Wireless for the Blind Fund The department acts as agents for this Fund and 30 new radio sets were distributed in 1968 and a further 30 in 1969. General Welfare of the Blind There are 150 Talking Book Machines on rental to blind persons throughout the Borough and of this number 43 rentals of £3 per annum are met by the Health and Family Services Committee on behalf of blind people in receipt of social security allowance. In addition to this service a grant is made to the National Library for the Blind in respect of 23 blind readers who regularly obtain books in Braille or Moon from this source» Holidays for the Blind A small party of six blind persons joined the group holiday to Hayling Island in both 1968 and 1969: similar arrangements are in hand for 1970. Sutton Association for the Blind This Association continues to give every assistance to the department in the matter of blind welfare. An amount of £400 was spent by them during 1968 on such items as holidays grants, Christmas presents, grants towards house decoration etc. In 1969 this amount was increased to £562, Many aids such as white sticks, writing frames, radio batteries to mention but a few were purchased by the Association and distributed to blind persons by this department. I would like to take the opportunity of expressing my most sincere thanks for the Association's good work in the field of blind welfare* In addition to its many grants to blind persons the Association donated the sum of £100 to the Low Visual Aid Centre which was opened in 1969 at Sutton General Hospital„ -141- HOUSING DIVISION PART V C. SMITH, DPA(Lond) FIHM Housing Manager. -142- HOUSING DIVISION The two years' work has again highlighted the urgent need for additional elderly persons' dwellings, and the Council has instructed the Borough Architect and Planning Officer to proceed as quickly as possible with building these dwellings in specified parts of the Borough. On the 1st October, 1968 the re-organised structure of the housing administration came into operation when rent collecting was transferred to the Borough Treasurer, repairs and maintenance to the Borough Architect and Planning Officer, with arrears procedure, rent rebates and housing management remaining with the Housing Manager, whose office was transferred from 24 Cheam Road, Sutton, to the Lodge, Honeywood Walk, Carshalton. New Properties During the years under review a total of 732 properties (159 in 1968 and 573 in 1969) were handed over from the Borough Architect and Planning Officer completed and ready for occupation. These were mainly at Roundshaw and Culvers Avenue, Carshalton. The total number of properties as at 31st December, 1968, was 5151o Rehousing of Special Categories 1968 1969 (a) Medical Priority 56 60 (b) Urgent Need 8 33 (c) Premises required for demolition or closing 22 Waiting List Position at 31st December 1968 2,300 applicants " " 31st December 1969 1,868 " Lettings Mutual Exchanges and Transfers 725 lettings were completed during 1969; 43 exchanges and transfers were arrangedo Families whose applications are considered to qualify for an award of medical priority and those designated as being in urgent need are so classified only after the most careful scrutiny of their circumstances. -143- Medical Priorities were awarded as follows 1968 1969 Category I (Priority as soon as suitable accommodation is available) 63 56 Category II (Priority within the points group) 77 37 Category III (No Priority on medical grounds) 134 94 The following criteria are applied to those applicants who are classified as in urgent need and to whom the Director's duty of arranging for rehousing is applicable (a) No other accommodation is available to them from any source. (b) They are homeless through circumstances over which they have no control or could not reasonably have been expected to foresee. In a number of cases permanent housing has been made available to enable separated families to be re-united, some by the discharge of children from Local Authority care. -144- ADMINISTRATION DIVISION PART VI "Wisdom denotes the pursuing of the best ends by the best means." (Francis Hutcheson 1694-1746) D.S. CLAPSON DPA (Lond) LMRSH MILGA Chief Administrative Officer. -145- The Council's re-organisation of its Committee and departmental structure and its review of gradings and establishment together with London Boroughs' Management Services Unit 0 & M Reports presented the main challenges to Administration during the years under review. In none of these interrelated areas had final solutions been reached as 1969 gave way to 1970. The Children's, Health & Welfare and Housing Departments came together on 24th May, 1968, to form the Health and Family Services Department, comprising Health, Welfare, Children's, Housing and Administration Sections. The Council's decision to review the departmental structure in the light of the report of the Seebohm Committee was implemented in December 1968 by the setting up of a Social Services Division comprising Children's, Welfare and some social work functions previously contained in Health. Based on the principles of the Maud and Mallaby reports the concept of Administration expressed in the re-organisation was one which applied in the Health and Welfare Department (where its implementation in practical terms was reaching fruition) but was new, in the sense of practical application, to Children's and Housing Departments where circumstances were different. In order to start planning for the expected new departmental situation a meeting of senior administrative staff was held on 9th April, 1968, with terms of reference "to discuss the function of a central administration section in the proposed Health and Family Services Department with particular reference to liaison between sections of the department on management services matters". The report of this meeting was adopted as a working brief for departmental administration in the areas of management services. Procedural instructions were subsequently issued covering supplies, finance, accounting and allied matters and staffing and establishment responsibilities. The 1968 Review of Gradings and Establishments proposed a reduction in the number of administrative, clerical, secretarial and typing staff in the department with a strengthened grading structure: this was accepted by Council and provided an authoritative basis on which future developments arising from the requirements of the operational services could be built. The ratio, of headquarters administrative, clerical and typing staff to operational staff and manual staff in the department (1:10) is favourable, a point which appears to be demonstrated by statistics provided by the Institute of Municipal Treasurers and Accountants. Only by a continuing process of methods study and improvement and job adjustments was it possible during 1968 and 1969 to contain the necessary administrative and clerical support services against the development of operational staff and services. On methods the reports of the London Boroughs' Management Services Unit have proved of value as have the services of the Internal 0 & M Officer whose assistance to the department during 1968 and 1969 was welcomed not only for the way in which it was extended but for the validity of his advise on work methods. Studies carried out with his assistance were:- Procedures for the Observation and Handicap Register Clinic Activities, including health visitors' and clinic records Work of Borough staff (social worker and clerk) attached to the Chest Clinic, St. Helier Hospital. -146- Home help service records. Orders and invoices. Accounting procedures. Social services filing. Domiciliary midwifery and home nursing. However, by the end of 1969 it became clear that development in the operational spheres could not be contained indefinitely within the reduced administration despite the success of the programme of internal 0 & M studies. Following the meeting held on 9th April, 1968, senior administrative staff met monthly to consider matters of common interest. In December, 1969, these meetings were widened to include clerical representation. Among the many items discussed was in-service training for administrative and clerical staff as a result of which on-the-job training was improved, understudying arrangements in sections and sub-sections was strengthened and a scheme for 'across the board' transfers was devised to broaden the knowledge and experience of comparably graded staff and to offset the tendency to over-specialisation within the department. A successful two months cross-attachment at Admin. Section Head level was started in December 1969 as a pilot scheme. A series of one-day seminars under the title 'Perspectives' was developed as a means of introducing clerical staff to the complexities of the new multi-disciplinary department, to development in both its formal and dynamic aspects and to basic 0 & M techniques of the sort which should be used on a day-to-day basis. The first successful seminar was held in February, 1969, and was followed by two others during the year. The regular staff meetings, together with improved in-service training within the Administration Division, facilitated the improvement in work methods and the acceptance of O & M techniques; for example, the use of Procedure Manuals associated with Job Descriptions was extended and improved within the division as a whole. Were it only possible to provide an adequate period of preparation and training prior to the effective date of a major re-organisation many difficulties could be overcome. In the second half of 1968 the departmental administration became involved with computer applications scheduled for implementation during 1969 and subsequently. During 19&9 this work continued and planning for decimalisation started. The assistance and co-operation of the Borough Treasurer's staff in this and, indeed, all matters of common interest during the two years under review, was appreciated. The application of the computer to accounting during 1969 facilitated the introduction of a streamlined and more authoratitive budgetary control system to the complex estimates of expenditure required by the department. In this sphere the computer made a direct contribution, not only to efficiency, but to our capacity to absorb additional work loads without additional staff. In conjunction with the Borough Treasurer's staff it was possible to implement Department of Health and Social Services Circular 43/68 on the form of accounts and unit costs for local health and welfare services in the Rate Estimates 1969/70. This was a substantial exercise; its successful completion enabled Sutton to meet the Secretary of State's recommendation that the proposals be adopted from 1st April, 1969, instead of taking advantage of the privisor "but in any case not later than 1st April 1970" as many Authorities appear to have done. - -147- For administration, 1968 and 1969 were years of planning (often against targets which were subject to possible change), of meeting the challenges of re-organisation, of building for the future on what was best of the past, of setting sights towards new horizons, above all of learning -learning, not only the application of new techniques and the developing tools of management, but of living and working together as one team during a period when, not unnaturally, loyalties still tended to be directed to the groupings of the past. Over and above everything else, just as in 1965, our prime task has been to support the Director, Service Chief Officers and operational staffs efficiently and economically, thus enabling them to devote a maximum of their time to their professional work. Whilst the meeting of 9th April, 1968, was essentially a business meeting considering such routine matters as supplies and accounting procedures, imprest accounts, organisation and methods, and so on, it might not be inappropriate to quote one paragraph from its report couched in general terms:".....'administration', be it of management services or of field services, is not an end in itself except, possibly, in the personal satisfaction of a 'job well done'. The end results of much of the proposed department's work in all disciplines can be assessed only in relation to the well-being of the population, they are not measurable in finite terms and will extend to generations yet unborn. Hence, our thoughts should be directed to the efficiency of means within the broad context of departmental aims. Others may see the end results of our efforts: our 'end' can, in the final analysis, be that, in true partnership, we have made some contribution to a whole which is infinitely greater than the sum of its parts." This 'true partnership' extends beyond Health and Family Services to all departments of the Authority, to statutory bodies and voluntary associations: for the co-operation, encouragement, advice and occasional criticism which we have received we are grateful. Without all these things which indicate the confidence of our colleagues and the good will of the public administration would be dull and lifeless. Unfortunately, during 1969 much of the impetus of the Council's reorganisation was lost owing to increasing doubts about the future of the department stemming from the publication of the first Green Paper and the impending legislation in implementation of the Seebohm Report. Possibly the greatest achievement of Administration during the two years v/as in proving that it could successfully support a broadly-based multi-disciplinary department. This was achieved with a reduced staff during a period of major re-organisation and operational development and it must be a cause for regret that any future re-organisation may well entail an increase in administrative costs over and above those arising directly from the growth of services to the public. -148-