LONDON BOROUGH OF SUTTON HEALTH AND FAMILY SERVICES IN SUTTON Incorporating the Statutory Reports of Medical Officer of Health Principal School Medical Officer 1970 W.H. Kinstrie MB ChB DPH Medical Officer of Health 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 APPENDIX STATISTICS Unless stated otherwise figures in brackets are for the year 1969. 1 MEMBERS OF COMMITTEES AS AT 31st DECEMBER, 1970 HEALTH AND FAMILY SERVICES COMMITTEE Councillor K.J. Martin (Chairman) Councillor F. Knights (Vice-Chairman) The Worshipful the Mayor, Alderman J.L. Bott, O.B.E. Alderman A.G. Taylor Councillors: R.J.M. Akhurst L.R.G. Brown J.W. Dunn G. Eve E.W. Goodall J.L.Izard A.J. Kenney C.W.M. McDowell, B.Sc., C.Eng., AMICE, MIPHI, M.lnst.H.E. N.F. Paul R.C. Squire, A.C.A. Co-opted Members: Mrs. Buck Mrs. Haydon Dr. Heywood Dr. Lawson Mrs. Marsden CHILDREN'S COMMITTEE Councillor K.J. Martin (Chairman) Councillor F. Knights (Vice-Chairman) The Worshipful the Mayor, Alderman J.L. Bott, O.B.E. Alderman A.G. Taylor Councillors: R.J.M. Akhurst L.R.G. Brown J.W. Dunn G. Eve E.W. Goodall J.L. Izard C.W.M. McDowell, B.Sc., C.Eng., AMICE, MIPHI, M.lnst.H.E. N.F. Paul R.C. Squire, A.C.A. Co-opted Members: Mrs. Driscoll Mrs. Heath Mrs. Marsden Mrs. Zaiger 2 The Worshipful the Mayor, Aldermen and Members of the Council. Mr. Mayor, Ladies and Gentlemen, I have the honour to present the third and last Annual Report of the Health and Family Services Department for the year 1970 incorporating the Statutory Report of the Medical Officer of Health and the Principal School Medical Officer. As a result of the Local Authority Social Services Act 1970 the Health and Family Services Department will cease as a combined department early in 1971 being replaced by separate Health, Social Services and Housing departments. Vital Statistics There is no significant difference in the birth rate or death rate compared with 1969 with the exception of the infant mortality rate which was at the lowest level recorded in the Borough. Infectious Disease The number of infectious diseases shows an increase compared with 1969. Infectious Hepatitis became notifiable during 1969 and the increase in 1970 is due to the increased number of notifications by general practitioners of the disease not previously notifiable. There is a small increase in the number of notifications of measles. Most if not all of these cases could have been prevented by vaccination against measles, but in spite of publicity given both by the Press, at General Practitioners' surgeries and at the Clinics, many parents have failed to have their children vaccinated. There are a number of reactions to measles vaccination but it must be emphasized that the complications of the disease of measles are at least ten times the possible complications from vaccination. There is a significant increase in the number of cases of whooping cough mainly due to immunisation against whooping cough being started in the second six months of life as recommended by the Department of Health and Social Security. Community Nursing Services During the year further progress was made on attachment and liaison schemes of health visitors, heme nurses and midwives to general practitioners, as strongly recommended by the Department of Health and Social Security. The building of the Clinical Centre at Cheam Nurses Home was begun during the year and it is anticipated that during 1971 the Home Nursing and Midwifery Services will be centralised at Cheam Nursing Home. There is an increasing demand for Home Nursing Services and as far as possible arrangements are made for cases to be nursed at home instead of hospital. Most chronically sick patients prefer to be at home rather than in hospital and on humanitarian grounds the Local Health Authority must accept the necessity for an adequate Home Nursing staff. Environmental Health The Chief Public Health Inspector has reported in detail on the Environmental Health Section. There has been an increasing volume of work as a result of new legislation particularly the Housing Act 1969. The delays in the implementation of the Clean Air Act 1956 are regretted. Every effort must be made to have all smoke control areas of the London Borough of Sutton completed by 1975. 3 Social Services By the end of 1970 a Social Services Committee had been formed and a Director of Social Services appointed. A report by the Director of Social Services including the work of the Children's Committee is incorporated in this report. Housing Report In the first paragraph of the Housing Report the Housing Manager refers to the provision of accommodation for elderly persons and I am glad to note that additional elderly persons' dwellings will be constructed during 1971. The greatest need in the borough as I have been emphasizing for several years is the need for old people's dwellings, not only for elderly persons who can live on their own in the community, thereby reducing the numbers on the waiting list for old people's homes, but also for transfer of elderly persons who are living in under-occupied accommodation. I hope that considerably more progress will be made on the construction of old people's dwellings during the next few years. Future Developments During the year progress was made in planning the Health Centre at Roundshaw and the conversion of Shotfield Clinic to a Health Centre by the provision of surgeries for general practitioners. The construction of the Junior Training Centre including a swimming pool in Robin Hood Lane was begun during the year. The Sutton and District Society for Mentally Handicapped Children have generously donated £5,500 towards the cost of the swimming pool. As a result of legislation control of the Junior Training Centre passes from the Health Committee to the Education Committee on 1st April, 1971. Construction of the Hostel for Subnormal Adults was commenced during the year but by the time it is completed control of the hostel will pass from the Health Committee to the Social Services Committee. The Health and Family Services Department comprising Health, Social Services and Housing was almost unique in the country and I personally regret the break-up of the department. The Chief Officers of the new departments will, however, continue to work in close collaboration. I have pleasure in recording my grateful thanks to all the staff of the Health and Family Services Department and particularly to the Principal Medical Officer, the Chief Public Health Inspector, the Chief Nursing Officer, the Director of Social Services and the Housing Manager for their contributions to this report. The helpful advice of all the other Chief Officers and their senior colleagues has been much appreciated. Finally I would express my thanks to all members of the Council and particularly to the members of the Health and Family Services Committee for their support and guidance throughout the year. W.H. KIIMSTRIE, MB., ChB., DPH. Medical Officer of Health Principal School Medical Officer 4 GENERAL STATISTICS AND SOCIAL CONDITIONS PART I INDEX Page No. AREA AND POPULATION 6 DEATHS 7 BIRTHS 8 W.H. KINSTRIE, MB, ChB, DPH. Medical Officer of Health and Principal School Medical Officer 5 AREA AND POPULATION Population tables on this occasion have been restricted to the Registrar General's estimated mid-year population and population by age-groups. Area in Acres Census Population Registrar General's Estimate of mid-year population 1951 1961 1966 1967 1968 1969 1970 10732 176151 169095 165840 165250 165430 166430 166480 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 1970 2240 9560 24000 180080 22600 166480 1969 2260 9740 22600 109030 22800 166430 1968 2370 9830 21900 108630 22700 165430 During 1971 there will be a National Census which will give accurate figures for the Borough. Rateable Value 1st April, 1968 1st April, 1969 1st April, 1970 £9,829,495 £10,041,245 £10,306,369 Estimated net product of a penny rate 1967/68 1968/69 1970 £39,487 £40,520 £41,145 Estimated number of separately assessed properties: 65,168 66,559 68,741 The following statistics have been supplied by the Registrar General:- Deaths from all causes Male Female Total Crude rate per 1,000 Home Population Adjusted rate per 1,000 population (Comparability factor 0.91) 1970 950 1022 1972 11.8 10.5 1969 971 1054 2025 12.2 11.1 1968 968 1074 2042 12.3 11.2 6 Deaths from certain causes Category 1950 1960 1965 1966 1967 1968 1969 1970 Tuberculosis, respiratory 39 9 8 7 9 5 4 8 Cancer, Uterus 11 17 15 18 15 11 15 17 Cancer, Bronchus, Lung 52 83 119 121 120 113 112 132 Coronary disease 291 362 379 374 400 523 460 443 Bronchitis 75 82 88 94 83 93 90 98 Suicide 15 19 14 13 15 20 24 17 Motor Vehicle accidents 13 18 23 22 23 18 27 26 All other accidents 26 17 22 18 26 23 26 20 The number of deaths by cause and sex and age groups is given in full in the Appendix to this report. Infant Deaths MALES FEMALES Age Legit. lllegit. Total Legit. lllegit. Total TOTAL Under 1 year 1970 8 2 10 16 1 17 27 of age 1969 13 - 13 23 4 27 40 1968 25 - 25 8 1 9 34 Under 1970 4 2 6 14 1 15 21 4 weeks 1969 of age 8 - 8 13 4 17 25 1968 20 - 20 6 1 7 27 Under 1970 3 2 5 13 . 13 18 1 week 1969 of age 6 - 6 8 4 12 18 1968 20 - 20 6 - 6 26 Infant Mortality Rates 1969 1970 England and Wales 1970 Infant deaths per 1,000 total live births 17.2 12 18 Legitimate infant deaths per 1,000 legitimate live births 16.4 11 17 Illegitimate infant deaths per 1,000 illegitimate live births 29.4 22 26 Neo-natal Deaths under four weeks per 1,000 total live births 11.0 9 12 Early Neo-natal Deaths under one-week per 1,000 live and stillbirths 8.0 8 11 Peri-natal Stillbirths and deaths under one week combined per 1,000 total live and stillbirths 14.0 15 23 7 Births 1st January - 31st December, 1969 LIVE STILL Legit." lllegit. Total Legit. lllegit. 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 stillbirths 2337 Live Birth Rate per 1,000 Home PoDulation Number of Stillbirths Males 6 Crude Adjusted by Comparability Factor 1.03 Females 8 Total 14 Stillbirth rate per 1,000 live and stillbirths 6.0 14.0 14.4 Births 1st January - 31st December, 1970 LIVE STILL Legit. lllegit. Total Legit. lllegit. Total M 1109 F 1074 M 62 F 76 M 1171 F 1150 M 7 F 11 M F - M 7 F 11 2183 138 2321 18 - 18 94.12% 5.88% 100% 100% - 100% Total live and stillbirths 2339 Live Birth Rate per 1,000 Home Population Number of Stillbirths Males 7 Crude Adjusted by Comparability Factor 1.03 Females 11 Total 18 Stillbirth rate per 1,000 live and stillbirths 8.0 13.9 14.3 8 EPIDEMIOLOGY PART II INDEX Page No. PREVALENCE AND CONTROL OF INFECTIOUS DISEASE 10 IMMUNISATION AND VACCINATION 11 VENEREAL DISEASES 12 MASS RADIOGRAPHY 12 IMMIGRATION 12 W.H. KINSTRIE, MB, ChB, DPH. Medical Officer of Health and Principal School Medical Officer (N.B. Figures in brackets are 1969 figures) 9 Prevalence and control of Infectious Disease The following table gives the total number of infectious diseases notified during 1970 together with the figures for 1969 for comparison. The full table is contained in the Appendix to this report. Infectious Diseases Notified during the period 1st January 1970 - 31st December 1970. Disease 1970 Diphtheria - ( - ) Dysentery 54 (21) Encephalitis 1 ( 3) Food Poisoning 6 ( 4) Infective Jaundice 43 (16) Malaria - ( - ) Measles 387 (369) Meningococcal Meningitis 1 ( - ) Ophthalmia Neonatorium 1 ( - ) Paratyphoid 1 (,- ) Poliomyelitis - ( - ) Scarlet Fever 74 ( 85) Smallpox - ( - ) Typhoid - ( 2) Tuberculosis (Pulmonary) 28 ( 19) Tuberculosis (Non-Pulmonary) 4 ( 5) Whooping Cough 52 (19) Infectious Diseases It will be noted that there were no cases of diphtheria or poliomyelitis during the year, undoubtedly due to the fact that the great majority of parents have their children immunised against these diseases early in life. There was an increase in the number of dysentery cases but the total is not significant. Many of the cases notified were family contacts of the original case. There has been an increase in the number of cases of pulmonary tuberculosis most of whom were in the later years of life. There were no cases amongst members of the staff and it was not necessary to carry out any investigations at schools for the sixth successive year. I have referred to the number of cases of measles in my introduction. 10 Immunisation and Vaccination 1st January - 31st December 1970 Type of Protection Completed Primary Courses Receiving Reinforcing Doses (Boosters) 1970 1970 Diphtheria/Pertussis/ Tetanus 1748 (1148) 740 (1805) Diphtheria/Tetanus 135 ( 89) 2361 (3005) Diphtheria 10 ( 15) 43 ( 114) Tetanus 78 ( 239) 420 ( 332) Poliomyelitis (Sabin - Oral Vaccine) 1095 (1584) 5067 (5406) Smallpox 1492 (1635) 437 ( 145) Measles 2594 (1405) - ( - ) Immunisation and vaccination is available at all the Council's Clinics and at the surgeries of general practitioners. An increasing percentage is being carried out by the general practitioners particularly at the Health Centre in Sutton. Rubella vaccination was introduced in the autumn of 1970 for girls between the ages of 11 years and 14 years beginning with girls aged 14, and 195 were vaccinated during 1970. The aim of rubella vaccination is the prevention of congenital abnormalities and has been introduced for girls immediately prior to the child bearing age. When all the girls between the age of 11 years and 14 years have been vaccinated it wili become routine for girls to be vaccinated when they reach the age of 11 years. There has been a continuation of the policy of immunisation and vaccination of school children going on trips abroad against smallpox, typhoid fever and cholera depending on which country is being visited. Vaccination against Tuberculosis (B.C.G.) 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. A. Contacts B. School Children and Students (1) Skin tested 127 (1) Skin tested 1719 (2) Found positive 1 (2) Found positive 66 (3) Found negative 126 (3) Found negative 1509 (4) Vaccinated 126 (4) Vaccinated 1504 11 Venereal Disease Notification of new cases of Sutton residents from hospital treatment centres during the last 3 years are as follows:- 1968 1969 1970 Syphilis 7 5 2 Gonorrhoea 44 56 45 Other Venereal Conditions 304 439 518 TOTAL 355 500 565 It will be noted that the percentage increase during 1970 was lower than the increase during 1969. Nevertheless it is a very high figure and the total number of cases is, in fact, almost as high as all other notifiable diseases combined. Every effort is made to follow up contacts and arrange for investigation and treatment if found necessary. The increase in the number of cases is undoubtedly due to two factors - more promiscuity amongst the young and the use of the contraceptive pill thereby diminishing the protection given by the use of sheaths. MASS RADIOGRAPHY The Director of the Mass Radiography Unit has supplied the following statistics: 1968 1969 1970 Total x-rayed 2822 11006 3018 Cases of Lung Cancer M F M F M F 1 1 4 1 2 - Cases of Pulmonary T.B. 1 - - 1 - - It will be noted that the number of defects found during 1970 was low. There has, in fact, been a decreasing number of cases found during the last few years as a result of which the Regional Hospital Board has under consideration reducing the number of sites at which the Mass Radiography Unit will be situate in future. The Unit has only one site in the Borough when a weekly visit is made to Wallington Town Hall. It has not been possible to persuade the Director of the Unit to increase the number of sites since the x-ray facilities at St. Helier Hospital are within reasonable distance of the remainder of the Borough. It will be noted that the total number of x-rayed during 1970 shows a considerable drop compared with 1969. In 1969 the Unit was available to the general public on several sites in the borough for several days but during 1970 no such service was offered to the general public. Immigration Under the Commonwealth Immigration Act 1962 the Medical Officer of Health is notified of all long-stay immigrants who are visited as soon as possible after arrival. Enquiries are made regarding the health of the immigrant, x-ray of chest is recommended and the immigrants are given advice regarding medical services. 12 The number of long-stay immigrants in the Borough remains remarkably small and the majority are employed in hospitals. Country where passport was issued as stated by Port Health Authority Number of advice notes received during 1970 from ports and airports relating to the arrival of immigrants Number of first successful visits paid during 1970 Number of Pulmonary Tuberculosis notifications received in respect of immigrants during 1970 (A) Commonwealth Countries 1. Carribean 18 (12) 2 (1) - (-) 2. India 12 (10) 9 (2) - (-) 3. Pakistan 6 ( 5) 5 (4) - (-) 4. Other Asian 11 (10) 4 (6) - (-) 5. African 10 ( 7) 2 (1) - (-) 6. Other 22 (10) 11 (7) - (-) (B) IMon-Commonwealth Countries 1. European 21 (45) 4 (14) - (-) 2. Other 16 (12) 1 ( 4) - (-) TOTAL 116 111) 38 (39) - (-) In addition Medical Superintendents at hospitals followed up 51 immigrants. (37) 13 HEALTH SERVICES DIVISION PART III PERSONAL AND SCHOOL HEALTH SERVICES INDEX Page No. 15 MATERNAL AND CHILD HEALTH 15 PREMATURITY 15 CONGENITAL ABNORMALITIFS 16 THE OBSERVATION AND HANDICAP REGISTER 16 DETAILS OF CLINICS 16 THE WORK OF CHILD WELFARE CENTRES 17 DISTRIBUTION OF WELFARE FOODS 17 THE WORK OF HEALTH VISITORS AND SCHOOL NURSES 19 DOMICILIARY MIDWIFERY AND HOME NURSING 21 LAUNDRY SERVICE FOR INCONTINENT PATIENTS NURSED AT HOME 21 DAY NURSERY SERVICE 22 CARE OF THE UNMARRIED MOTHER AND HER CHILD 23 RECUPERATIVE HOLIDAYS 23 DENTAL CARE OF MOTHERS AND YOUNG CHILDREN 23 HOME HELP SERVICE 24 CERVICAL CYTOLOGY 24 CHIROPODY SERVICES 25 THE CARE OF THE MENTALLY HANDICAPPED 25 MENTAL ILLNESS 26 SUBNORMALITY 27 HEALTH EDUCATION 28 NURSING HOMES 28 NURSES' AGENCIES ACT, 1957 29 MEDICAL ARRANGEMENTS FOR CHILDREN'S HOMES AND RESIDENTIAL NURSERIES 29 STAFF MEDICAL EXAMINATIONS 31 SCHOOL HEALTH SERVICE 31 PERIODIC MEDICAL INSPECTIONS 31 SPECIAL MEDICAL EXAMINATIONS AND RE-EXAMINATIONS 31 HANDICAPPED PUPILS 31 PERSONAL HYGIENE 31 MEDICAL TREATMENT 32 SCHOOL DENTAL SERVICE 32 SPECIAL SERVICES 32 AUDIOLOGY 33 SPEECH THERAPY 33 CHILD GUIDANCE SERVICE 33 SCHOOL PSYCHOLOGICAL SERVICE 34 OBSERVATION AND DIAGNOSTIC CLASSES 34 SCREENING PROCEDURE FOR INBORN ERRORS OF METABOLISM 34 HANDICAPPED PUPILS AND SPECIAL SCHOOLS 37 EMPLOYMENT OF CHILDREN OF SCHOOL AGE 37 PROVISION OF MEALS AND MILK W.H. KINSTRIE, MB., ChB., DPH., Medical Officer of Health and Principal School Medical Officer Figures in brackets are for the year 1969 14 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, and are complementary to the services provided by the Regional Hospital Boards and Executive Councils. The Local Authority Health Services give particular emphasis to the more vulnerable members of the community - the very young, expectant mothers, the elderly and the handicapped and are concerned with the maintenance of mental and physical health and the early detection of abnormality. Cases requiring treatment are referred either to the general practitioner or to hospital. Maternal and Child Health Births Notified by Medical Practitioners or Midwives 1st January to 31st December, 1970 (a) In the area including those normally resident elsewhere (b) Resident in the area including those born elsewhere, i.e. adjusted by inward and outward transfers Live 2965 (3022) Live 2363 (2380) Still 25 ( 19) Still 19 ( 13) TOTAL 2990 (3041) TOTAL 2382 (2393) Births in hospital 2151 (2127) Births at home 231 ( 266) The number of home confinements continue to decrease but the work of the midwives has in fact increased since they delivered 65 (26) cases in hospital and provided additional ante-natal and post-natal services for hospital booked cases. Prematurity Full schedule showing statistics will be seen in the Appendix to this report. The following table shows the size of the problem with regard to the serious loss of infant lives associated with prematurity and during the first month of Iife:- Total Non-Premature Premature 1970 1969 1970 1969 1970 1969 Live Births 2363 2380 2229 2284 134 96 Deaths among live births in the first month of life 21 25 9 10 12 15 Still births 19 13 9 5 10 8 The Department of Health and Social Security's definition of a premature birth is one when the infant at birth weighs 5y2lbs. 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 during 1970:- 15 Total No. of children born with abnormalities 38 (67) Number of those who were stillborn 3 ( 2) Number of those born alive who died within 10 days Nil ( -) Number born with serious defects 9 (11) Number which were of a comparatively minor nature 29 (56) The Observation and Handicap Register There is a growing awareness of the importance of discovering handicapped children as early as possible. Many children acquire their handicapping conditions in the pre-natal, neo-natal or early post-natal periods of life. Infants who have been exposed to unfavourable hereditary 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 is assisted to the extent necessary to make full use of their 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 they are aged 5 years by regular medical examination and full assessment of their developmental progress. Close co-ordination of the work of various agencies who are concerned with the wellbeing of a handicapped child is essential and this involves close contact with the general practitioners, social workers, hospitals and voluntary organisations. The Observation and Handicap Register provides the means by which this is achieved and when necessary ensures the future provision of educational facilities suited to the child's ability and handicap. The early years of the child's life are a vitally important period in his development. The young child with a disability which may interfere with normal learning processes needs early help to minimise or oversome the handicap before the child's optimal learning period has passed. The development of such children is particularly vulnerable because of restrictions which may be imposed by the disabilities on the range and quality of the child's experience and by unfavourable or unenlightened attitudes of parents." During 1970 89 pre-school children had special examination and full assessment by the Principal Medical Officer. Following these examinations 32 children were recommended for attendance at day nurseries; 25 were recommended for attendance at a nursery class; 4 children were recommended for placement in the nursery section of a day physically handicapped school; 1 child for a school for speech disorders; and 4 children to the class for non-communicating children aged under 5 years. See tables in the Appendix of this report. Details of Clinics The Borough is served by Robin Hood Lane Health Centre and eight purpose-built clinics supplemented by a limited number of sessions held in five premises rented on a sessional basis. It is hoped that the plan to build a health centre to serve the Roundshaw area, replacing the present temporary clinic houses in two adapted flats, together with the plan to provide health centre facilities by extending the present Shotfield Clinic in Central Wallington, will be fully realised by the end of 1972. The Work of Child Welfare Centres The work of the child welfare centres consists of the supervision of the development of all children under the age of 5 years with particular emphasis being placed on those children who are considered 'at risk' and those on the Observation and Handicap Register. 16 Early detection of abnormality or development is an essential part of the service. Immunisation and vaccination against infectious disease is carried out at clinics as well as by the family doctor. Special Developmental Clinics are held at all the major clinics when children are seen by appointment for assessment of their mental and physical development. Statistics of attendance at the clinics are given in the Appendix of this report. Distribution of Welfare Foods Government Scheme The Council acts as agent for the distribution of National Dried Milk, Cod Liver Oil, Orange Juice arid Vitamin A and D tablets to authorised beneficiaries and the actual distribution is carried out by members of the Women's Royal Voluntary Service whose help in this scheme is greatly appreciated. Issues 1st January - 31st December, 1970 (1969) National Dried Milk (tins) Cod Liver Oil (bottles) Orange Juice (bottles) A & D Tablets (packets) 12240 (11852) 1661 (1871) 60206 (53665) 3574 (3225) Proprietary Welfare Foods Infant Welfare clinics 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. The sale of proprietary foods is undertaken by voluntary committees at all the clinics, working in close co-operation with the health visitors. The small profit made by these voluntary committees is used to further the work at the clinics. The help given by voluntary workers not only in the sale of proprietary welfare foods but in assisting at infant welfare and other clinics is greatly appreciated. The Work of Health Visitors and School Nurses Health Visitors 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 1. Clinic Sessions Ante-Natal and Post-Natal 287 (337) Infant Welfare and Toddlers examination 1901 (1318) Mothercraft 305 (301) Parentcraft 161 (120) Health Education: Schools, Red Cross, St. John's Ambulance, Youth and Adult Organisations 253 (42) Hearing tests 174 (220) 17 2. Health Visitors case load for children aged 0 - 5 years 0 - 1 year 1 - 5 years 0 - 5 years Families 2363 (2218) 9113 (9818) 11476 (12036) 9012 (9273) Average case load for staff in post 24 (25) 94 (88) 538 (393) 632 (481) 360 (371) The ratio of health visitors to population, as advised by the Department of Health an< Social Security working party reporting in 1961, was a ratio of 1 to 4,300 population. The ratio for Sutton in 1970 was 1 to 6,430. 3. Home Visits Children 0 - 5 years 26269 (27392) Persons over 65 years 2345 (740) 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:- 459 (508) Screening Procedures Research continues in the Borough with continuous surveys of children born with spina bifida and other congenital malformations. During 1970 we also took part in the Oxford Survey of childhood malignancies and the British Births Survey. The following screening procedures are offered to the parents of all infants:- (a) The Guthrie test at 6 days of age replaced the phenylketonuria test at 3 weeks of age on the 1st January, 1970. No cases of phenylketonuria were detected during 1970. (b) Cystic Fibrosis at 3 - 4 months of age in conjunction with the Medical Superintendent of Queen Mary's Hospital for Children. No cases were detected in 1970. (c) Hearing test at 8 months. 40 cases referred to Audiology Clinic. It was important to detect any child with any of these abnormalities before symptoms are apparent and appropriate treatment arranged very early in life, thereby minimising severity of the defect. Audiology Clinic Children under 5 years of age referred to the Audiology Clinic for a more detailed examination of their hearing in the following circumstances:- 1. Children failing their screening test of hearing at 8 months of age. 2. Any baby whose mother has a history of rubella in pregnancy. 3. Where there is a family history of deafness. 4. All children with slow speech development. 5. Any child suspect of any hearing loss. 6. Any child who has had rhesus incompatibility at birth. The week of the Audiology Clinic has increased during 1970. This is due to the awareness of the importance of early detection of hearing loss in young children and the necessity for early treatment. The number referred during 1970 are as follows:- 18 Age New Cases Total Consultations Referred to ENT Dept. No. of Hearing Aids issued 0 - 2 years 40 (27) 65 (35) 2 (2) 2 (-) 2 - 5 years 69 (75) 108 (86) 10 (14) - (-) The Mothers' Clubs These clubs are held at the Local Health Authority clinics for any mother with young children under 5 years of age. They are held every week or fortnight in the evening or during the day, and if they are held during the day there is a rota for the mothers to care for the children in another room. The Health Visitors initially form the club, subsequently handing over the responsibility of the actual running of the club to the mothers, but are always available for advice and guidance. Speakers at the club are varied and topical, with at least half of the time being spent on Health Education. The Mothers' Clubs are very entertaining and the young mothers make friends outside the home and enjoy social activities coupled with stimulating educational activities which is a morale booster to young mothers and those moving into the area. Advisory Clinics for the Elderly These clinics are held at the major clinics in the Borough and are attended by both men and women after they reach pensionable age. A health assessment is carried out at the first visit and any abnormality detected referred to the family doctor. Subsequent visits include talks on nutrition, prevention of accidents, hobbies, etc., and following the talks keep-fit exercises. These clinics supplement the work of the Day Centres for the Elderly. Health Visitors attached to General Practitioners In accordance with the Department of Health and Social Security Circular 13/69 which recommends attachment of health visitors etc., 12 health visitors were attached to general practitionei at 31st December, 1970. Domiciliary Midwifery and Home Nursing The Domiciliary Midwifery and Home Nursing Service is operated from the Nurses Home at Sutton and Cheam. The Nurses Home at 8, Stanley Park Road, Wallington, was closed in October, 1970. The Department of Health and Social Security Circular 13/69 recommended the attachment of nurses and midwives to general practitioners. Attachments commenced in 1969 and by 31st December 1970 the numbers attached were as follows:- General Practitioners Practices Home Nurses 11 full-time 9 part-time S.E.N.s 2 full-time 1 part-time 37 17 Nursing Auxiliary 1 full-time Midwife Liaison 12 16 12 Clinic Nurses 2 part-time 9 4 19 The following tables give some indication of the volume of work carried out:- HOME NURSING (a) Total number of persons nursed 3290 (3153) (b) Number of persons aged under 5 at 1st visit 85 (34) (c) Number of persons aged 65 or over at 1st visit 2186 (2093) (d) Total number of visits made by home nurses 128253 (122186) DOMICILIARY MIDWIFERY No. of domiciliary confinements attended by midwives under N.H.S. arrangements during 1970 No. delivered in institution but discharged to D.M. before the 10th day Total No. of visits made by D.M. Ante-Natal cases visited by D.M. Doctor Present Doctor not present Total 39 (51) 185 (219) 224 (270) 627 (529) 14301 (9684) 5178 (4769) Midwives booked cases transferred to hospital during confinement During 1970 38 (26) patients were transferred to hospital during pregnancy or labour, 27 of whom were delivered by domiciliary midwives in hospital. Refresher Courses for Midwives, District Nurses and Pupil Midwives Refresher Course attended: Midwives 2 (2) District Nurses 8 (6) Practical Work Instructors Course attended: District Nurses 2 ( -) District Nurse Training Student District Nurses who completed training and passed the examination 7 (8) 2 state enrolled nurses completed their district training; both were successful and one passed with distinction. Pupil Midwifery Training Pupil Midwives from Epsom and St. Helier Hospital Maternity Units receiving their Midwifery Part II 25 (28) training (all were successful in their examination) Local Supervising Authority (Midwives 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 year 1970:- 100 (97) Summoning of Medical Aid During 1970 medical aid was summoned under the Midwives Act 1951 by midwives in the following number of cases:- 20 For domiciliary cases:- (a) Where the medical practitioner had arranged to provide the patient with maternity medical services under the National Health Service 47 (147) (b) Others - ( - ) For cases in hospital 328 (353) Notification from Midwives During 1970 the following notifications were received from midwives:- Sending for medical aid 375 (500) Stillbirths - (2) Liability to be a source of infection (including pyrexia) 6 (10) Death of mother or baby - ( - ) Ophthalmia Neonatorum During the year 1970 midwives sought medical aid for suspected cases of ophthalmia neonatorum in respect of 7 (14) babies, but no cases were notified. 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. Laundry Service for incontinent Patients Nursed at Home There is a continued demand for the laundry service for incontinent patients both in the borough of Merton and in Sutton. The service is greatly appreciated both by the patient and the relatives as well as by the district nurses. The total number of cases during the year 1970 was as follows:- Total during year Number of patients on books at end of year London Borough of Sutton 71 (72) 32 (33) London Borough of Merton 98 (101) 49 (51) Total 169 (173) 81 (84) Day Nursery Service The Council has only one day nursery at El Doret, 717, London Road, North Cheam, to which children are admitted in the following priority groups:- (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. 21 Of the 52 places available there was an average daily attendance of 36 (39). The average attendance was less than in the previous year as a result of an outbreak of infectious disease at the Nursery early in 1970. There are reciprocal arrangements with neighbouring authorities for the admission of children to day nurseries in other boroughs and three children were so placed in 1970. Nurseries and Child Minders Regulation Act 1948 as amended by the Health Services and Public Health Act 1968 The above Act was amended by the Health Services and Public Health Act 1968 and the main purpose of the amendment was to register child minders who had the care of one child whereas previously child minders did not have to be registered unless they were caring for three or more children. The following table indicates the increasing volume of work under this Act:- Approved for registration during 1970 No. who cancelled registration during 1970 Child Minders Day Nurseries Child Minders Day Nurseries 103 (89) 16 (5) 41 (7) 6 (1) Nurseries and Child Minders Regulation Act 1948 Premises Registered at end of year Daily Minders registered at end of year Factory Other Nurseries (a) Number as at 31.12.70 - ( - ) 55 (45) 179 (117) (b) Number of places and number of children minded as at 31.12.70 - (-) 1258 (1054) 420 (337) Authority has been given to the Medical Officer of Health to place children in the priority groups in private day nurseries or with private child minders when it is unreasonable to expect the mother to take the child to El Doret which is on the north west borough boundary, or when no vacancies are available at the Council's Nursery. 105 (38) children were placed in private day nurseries or with child minders for varying lengths of period throughout the year. Most of the placements were for part-time attendance. Care of the Unmarried Mother and her Child The residential care of the unmarried mother during the later stages of pregnancy and of the mother and her child during the first few weeks after confinement has been undertaken by voluntary organisations. The Sutton Moral Welfare Association as well as providing social work support to unmarried mothers runs an 18-bed Mother and Baby Home. The Council makes a grant to the Association and in return has admission free of charge for up to one-third the total number of beds available. The number of cases admitted to the Mother & Baby Home during 1970 were as follows:- 22 Name and Address of Home "The Haven", 2, Camden Road, Sutton Provided by Sutton & District Moral Welfare Association Type of Admission No. of cases admitted during year No. of beds occupied at 31st December 1970 Average Duration of stay Ante-Natal 49 (49) 9 (8) 42 days Post-Natal - (- ) 8 (9) 42 days Shelter - (- ) - (-) - TOTAL 49 17 A number of unmarried mothers prefer to be placed in homes some distance from the Borough and at times the Sutton Home is unable to accept all the Sutton cases. Under these circumstances the unmarried mother is placed in the most appropriate home in another area and special arrangements are made, if necessary, for the continuance of her education. The total number of cases placed outside the Borough in 1970 was 8(16). Recuperative Holidays Arrangements are made for children and adults recommended on medical grounds for recuperative holidays to be placed in the most appropriate convalescent or holiday home. During 1970, 11 children (4) under the age of five years; 15 (17) school children; and 51 (53) adults were sent for recuperative holidays. Excluding children and those on social security benefit a contribution is paid by the patient, the assessment of which is carried out by the Borough Treasurer. Dental Care of Mothers and Young Children There has been little change in the pattern of dental treatment for expectant and nursing mothers and children under five years old. The number of mothers attending dental clinics for treatment continues to be small but the ratio of fillings to extractions and dentures has risen. The number of pre-school children attending for treatment and the number of teeth conserved remained fairly constant and there was a satisfactory drop in those attending as 'emergencies' and in the number of teeth extracted. The total number of pre-school children attending for dental inspection only was lower than the previous year. This was very disappointing as it was hoped that with the opening of the new Health Centre in Sutton these visits would have increased. For statistics see table in the Appendix of this report. Home Help Service Recruitment of full-time home helps continues to be difficult and the Service is dependent on part-time home helps. One full-time domestic auxiliary was recruited during the year. Although there is a 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 1970. 23 Home Help to Households No. of Cases: Aged 65 or over on 1st visit during 1970 Chronic sick and T.B. Mentally Disordered Maternity Others TOTAL 969 (948) 124 (135) 2 (3) 84 (74) 108 (108) 1287 (1268) No. of Home Helps at 31.12.70:- (a) Full-time 12 (13) (b) Part-time 102 (102) (c) Full-time equivalent of (b) 58.80 (59.6) (d) Total 70.80 (72.6) Cervical Cytology Sessions are held at all the major clinics in the borough and during 1970 frequent evening sessions were arranged for those women who were unable to attend day sessions. In addition to the cervical smears all women have a complete pelvic examination, breast examination, urine test, and blood pressure. The National scheme is for women over the age of 35 years. The Consultant Cytologist at St. Helier Hospital is carrying out a research programme which includes women over the age of 25 years who have had one or more children. In practice any woman who wishes to have a cervical smear is given an appointment. An increasing number of cervical smears are carried out by family doctors. The following tables indicate the work carried out during 1970:- Total number of women who had one or more cervical smears taken 2797 (2695) Cases having smears taken for the first time 1234 (1838) Number of repeat smears 1563 ( 857) Classification of Smears Class No. of Smears I 1924 (1875) II 869 (812) III 4 (6) IV (1) V (1) The family doctors are informed of the results in all cases and where necessary they arrange for hospital investigation. 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. (iii) Expectant mothers. 24 The following table gives the total number of cases who attended clinics and the total number of treatments:- Total number of cases attended 2934 (2735) Total number of treatments 12603 (10950) Sessions are held at the majority of the Council's clinics, at day centres, as well as at the Council's old people's homes and old people's homes run by voluntary organisations. Where the elderly or handicapped person is unable to attend the clinic, domiciliary visits are made and 5576 (3709) visits were made in 1970. There is an increasing demand for chiropody and unfortunately during 1970 not only was it impossible to recruit full-time chiropodists but at times there was difficulty in obtaining the services of sessional chiropodists. Every effort is made to give an early appointment to new cases but there was some delay in follow-up visits as a result of this shortage. The Care of the Mentally Handicapped Mental Illness 1. Cases 763 (527) referrals were received from all sources during 1970 and of this number 351 (236) required in-patient treatment in psychiatric hospitals, 130 (67) on an informal basis and 221 (182) under statutory procedures. At 31st December 1970, 247 (148) patients were being supported in the community. 13(7) patients were placed in hostels or voluntary homes outside the Borough for varying periods during the year and at 31st December 1970 12 were still in residence. 2. Hostel Gower House Hostel which opened in April 1966 continues to play an important part in the domiciliary re-settlement of psychiatric patients. The hostel was well-occupied during the year resulting in 10 (13) admissions and 8 (13) discharges. At 31st December 1970, 11 persons (10) were in residence at Gower House. 3. Boarding Out Scheme The Boarding Out Scheme is functioning on a very limited basis; only two flatlets occupied by previous residents from Gower House Hostel are subject to support under the scheme. 4. London Borough of Sutton Association for Mental Health This Association, which was formed in 1966 has been very active during the year 1970 and works in close collaboration with the statutory officers of the borough in helping to give support to the mentally ill living in the community. The two Social Clubs run by the Association continued to flourish during the year and meet a great need in providing social activities for those people suffering from mental depression who would not normally be able to enjoy such facilities. The Social Clubs are:- (a) The Woodcote Social Club which meets on Tuesday evenings in the Day Hospital at 77, Woodcote Road, Wallington. Toe H are very much involved in organising club activities on behalf of the Association. (b) The Garden Club which meets on Tuesday afternoons in the Friends Meeting House, Sutton. During the year the Association purchased a minibus and this is used to transport people to and from the social clubs and also takes patients and their families to hospital. It is also used to take patients and their friends on outings to the sea and country. 25 5. Rota Duty The 24-hour on-call duty rota of mental welfare officers continued under the joint arrangements with the London Borough of Merton. Mental Handicap (Subnormality) 1. Day Training At 31st December, 1970, 123 sub-normal children and adults were receiving day training at various training centres within and outside the Borough as follows:- Sutton Training Centre 39 children (38) Morden Junior Training Centre (London Borough of Merton) 10 children ( 5) Banstead Adult Technical Training Unit (Surrey County Council) 63 adults (63) Caterham Training Centre 2 adults ( 2) (Surrey County Council) 1 child ( 1) Waylands Training Centre (London Borough of Croydon) 1 adult ( 1) Bensham Training Centre (London Borough of Croydon) 1 adult ( 1) Coldharbour Training Centre (London Borough of Croydon) 1 child Croydon Spastic Society (Children's Centre) 7 children ( 5) Croydon Spastic Society (Adult Work Centre) 3 adults ( 2) In addition 5 children attended Queen Mary's Hospital for Day Hospital care and training. The co-operation of neighbouring authorities who have enabled us to fulfil our obligations by making placements available for subnormal children and adults is appreciated. 2. Residential Care (other than hospital) Special arrangements were made in 15 cases where subnormal children and adults needed to be maintained in residential establishments for care and training. 3. Hospitals During the year 31 (19) children and adults were admitted to hospital for short-term care to enable parents to have a holiday or because of a family crisis. We are grateful to Queen Mary's Hospital, Carshalton and The Manor Hospital, Epsom, for arranging to accept these persons for periods ranging from two to eight weeks. Only 2 (2) subnormal adults and 1 (-) subnormal child were received into permanent residential care in hospitals for the subnormal during the year. 4. Community Support The Mental Health Section has responsibility for supporting all subnormal persons over 5 years of age in the community and at 31st December, 1970 236 (230) families were subject to routine visiting by mental welfare officers. 5. Holidays As in previous years, holiday arrangements for adults attending Banstead Technical Training Unit were made by the Surrey County Council. Four of our children attending the Sutton Training Centre were able to join parties of Surrey children on organised holidays and we are grateful to our colleagues in Surrey for their assistance. 26 Health Education In addition to Health Education carried out by teachers in schools many of the professional staff of the Health Department including medical officers, dental officers and health visitors are responsible for health education as part of their normal duties. The demand for health education from schools as well as from the general public continues to increase. Health education in the borough is co-ordinated by the Health Education Officer who works from the Health Education Centre at Rochester Road Clinic, Carshalton, where there is an excellent supply of audio-visual aids including 21 films and 85 sets of teaching slides. High Schools The main programme for health education in high schools is carried out by one of the school medical officers and during term time she is almost fully employed on this work. Health education is part of the syllabus for all children in high schools and in the older age groups emphasis is placed on personal relationships, and social health problems. Special sessions are devoted to the use and misuse of drugs. Primary Schools The teachers in primary schools are increasingly undertaking health education but are supplemented by the talks given by health visitors. Before the talks on sex education are given the films and slides used are seen by parents. Health Education in Clinics There is continuous health education at all clinics including the dental clinics. Reference has been elsewhere in the report to the health education given in Mothers' Clubs and Geriatric Advisory Clinics. Adult Further Education The Health Education Officer was involved in the establishing of a pilot course on retirement. There has been an increasing demand for speakers and films on health education by Youth Clubs and various Societies. Home Safety The Home Safety Committee has continued to meet regularly and during 1970 one Committee was formed for the whole Borough. The help and advice given by the Committee is greatly appreciated. Five home safety courses mainly for young people were held during the year and those attending regularly were presented with certificates by The Worshipful the Mayor. In addition an Inter-School Poster Painting Competition was held when the subject of the poster was based on home safety. A Poisons Campaign was held during-the year and 25,000 unused tablets etc. were collected and destroyed. Hazard House the teaching aid which highlights 53 home hazards has been in continuous use in primary schools, libraries and clinics and in addition, achieved national fame when it was on show at the National Home Safety Conference. Home Safety continues to be an important part of the health education programme. 27 in-Service Training Anatomy and Physiology in Primary Schools A course for primary school teachers on the content and methods of teaching basic anatomy and physiology was arranged at the Teachers' Centre. The Health Education Centre provided audio-visual and other teaching aids for demonstration. As a result of this course a Working Party was set upt to meet in 1971 and discuss health education in primary schools. The Health Education Officer was asked to join the Working Party as a member and Dr. I. Clowes named as one of the specialists to be consulted. Mothercraft for Midwives The Principal Nursing Officer for Home Nursing and Midwifery arranged that all her staff should undergo a short course of lectures on the content and methods of group teaching in mothercraft and family planning run by the Health Education Officer. The content of the above course was integrated into the Community Health Course for Student Midwives. Health Education Projection Courses The Training Officer examined and the Medical Officer of Health awarded certificates of proficiency to twelve district midwives and nurses. Loans of Teaching Sets from the Health Education Centre during the year 1970 Subject Matter Clinics Schools Elsewhere Total Anatomy and Physiology 11 149 - 160 Dental Health 4 9 1 14 General Health Education 146 134 6 286 Health, Social & Welfare Services 7 5 3 15 Home Safety 23 29 5 57 Parentcraft 191 21 - 212 Social Diseases 13 163 1 177 TOTAL 395 510 16 921 Nursing Homes The following registered nursing homes are situated in the borough:- Carshalton Nursing Home Ltd., 28, Salisbury Road, Carshalton. 103, Woodcote Road, Wallington. The Avenue, 32, The Avenue, Cheam. The Red House, 40, Burdon Lane, Cheam. St. Margaret's, 17, Overton Road, Sutton. Woodcote Grove House (Friends of the Poor and Gentle-folks' Help), Woodcote Park, Coulsdon. 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). Nurses' Agencies Act, 1957 In the year 1970 there was only one nurses' agency licensed under this Act in the Borough: 28 The Empire Nursing Association. Licences are issued annually subject to re-inspection and satisfactory report. Medical Arrangements for Children's Homes Reception Home, Rosebery House, 7/9, Rosebery Road, Cheam. Throwley House, 10, Throwley Road, Sutton. Malvern House, Foxley Road, Kenley. Camperdown Children's Home, 146, Woodcote Road, Wallington. Dean House, 95, Nutfield Road, Merstham. Working Girls' Hostel, 57, Montagu Gardens, Wallington. A general practitioner residing near the Reception Home is responsible for the examination of new admissions and discharges as well as for medical treatment. At all other Homes a general practitioner is responsible for medical treatment. Examination of new admissions and discharges are carried out by medical officers in the department. In addition, a medical officer visits all the Homes regularly, carries out routine medical inspections annually on all children resident in the Home and is responsible for seeing that any special investigations and immunisations against infectious disease are carried out. Advice is also given to the houseparents on any medical aspect concerned with the care of the children. Each Home is inspected regularly by the Principal Medical Officer and a report on environmental conditions and the health of the children submitted. Staff Medical Examinations Officers In order to ascertain fitness for employment, the candidate either completes a medical questionnaire or a full medical examination is carried out by 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. 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. 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. 29 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 after the age of 65 years are required to pass a medical examination and are re-examined annually. Heavy Goods Vehicle Driving Licences - Road Transport Act 1968. A medical examination is now required to ascertain fitness prior to prospective drivers of heavy goods vehicles being granted a licence. Medical Examinations undertaken during 1970:- Officers (excluding teachers) 188 (322) Teachers 298 (281) Manual staff 297 (224) Extensions of sick pay 11 (24) Retirement due to ill-health 14 (11) Extensions of service 129 (128) Heavy goods vehicle drivers 21 ( - ) Trainee Teachers 196 (166) Medical Questionnaires 209 ( - ) Other Medical Examinations Officers (including teachers) who had chest x-ray only 84 School Canteen staff who had chest x-ray only 241 School Canteen staff who had chest x-ray and bacteriological investigations 144 30 School Health Service Periodic Medical Inspections During 1970 periodic medical inspections were carried out on : (i) all new entrants to school (ii) all pupils in their eighth year (iii) all school leavers Selective medical examinations were carried out on all children on entry to High Schools. The parents of many of the children requested medical examination whether selected or not, as a result of which about 80% of all the children in the age group were examined. Preliminary arrangements have been made for selective medical examination for children in theireighth year to commence in 1971. In addition to periodic medical inspections pupils have vision test at 5, 8, 11, 13 and 14½years and a colour vision test at the age of 11 years. Pupils aged 6 years have screening test for hearing carried out by an Audiometrician. Special medical examinations and re-examinations Pupils are examined when necessary following periodic medical inspection or when referred for examination by the head teacher or school nurse and at the request of parents. These pupils are examined either at the school or at general medical clinics. The total number of re-examinations in 1970 was 3,048 (1,184). Full details of defects found at periodic and special medical inspections are given in the appendix to this report. Handicapped Pupils The following table shows the number of handicapped children attending primary and high schools as at 31/12/70 :- (i) Epilepsy 56 (ii) Heart defect 22 (iii) Hearing defect 35 (iv) Diabetic 19 (v) Physically handicapped 59 (vi) Partially sighted 8 (vii) Other handicaps 3 Personal Hygiene Routine hygiene inspection of pupils is carried out either at the request of the head teacher or at the school medical officer's or school nurse's discretion. Regular hygiene inspections each term have not been necessary at any school during 1970. The total number of inspections carried out was 4,676 (8,261) and the number of children found to be infested was 83 (99) Minor Ailments The principal minor ailments treated at general medical clinics 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 particularly the treatment of verrucae and many cases are referred to her by general medical practitioners. The total number of pupils treated for minor ailments, excluding skin diseases, in 1970 was 169 (222). The total number of pupils treated for skin diseases was 284 (292). 31 Defective Vision By arrangement with the Executive Council treatment of defective vision and squint can be carried out at local authority clinics. The total number of pupils treated for defective vision, including squint, in 1970 was 1223 (1381). Spectacles were prescribed for 484 (347). Diseases and defects of ear, nose and throat The total number of children treated for these defects in 1970 was 124 (122) of whom 24 (5) had operative treatment mainly for tonsils and adenoids. Orthopaedic Defects Physiotherapy sessions for minor orthopaedic and postural defects are held at clinics and in addition at Carew Manor Special School and the Junior Training Centre. The total number of pupils treated in 1970 was 223 (348). School Dental Service The increase in the school population has created difficulties for the school dental service especially in the area served by Shotfield Clinic. The increase in the number of children on the Roundshaw Estate and their need for extensive dental treatment (73% of children in need of treatment compared with the Borough average of 49.3%) has resulted in the routine school inspections and good recail system at Shotfield being in arrears in spite of an increase in dental staff at that clinic. With good dental health education and the hope of a new Health Centre at Roundshaw the situation should improve. There has been little difference in the number of children inspected and treated or the number of teeth filled but the number of extractions has risen considerably. This is most noticable in the age group 5 - 9 years where the number of permanent tooth extracted rose from 29 in 1969 to 75 in 1970. Health Visitors have played an increasing part in dental health education, visiting schools giving talks, showing films and demonstrating correct tooth brushing methods on models made at the Health Education Centre. One school in the Borough had a Dental Health Week with a poster competition and a play with a 'Toothy' ending written and acted mainly by the children. Statistical tables are given in the Appendix to this report. Special Services (a) Audiology 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 partially 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. 32 The teacher for the deaf visits each school which a child attends who has a hearing loss to discuss the treatment and progress of each child with the head teacher. The co-operation of teachers in this respect is much appreciated. New cases supplied with hearing aids in 1970 11 (9) Pupils registered as having been fitted with hearing aids 51 (41) Total number of children seen by Audiometrician 2477 (2191) Number referred for further investigation 136 (116) (b) Speech Therapy Speech therapy sessions are held at clinics and also at Carew Manor Special School, the Junior Training Centre, Observation and Diagnostic Classes and at a private Special School in the borough. The total number of children attending for speech therapy in 1970 was 287 (262). (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 with School Psychological Service are based at the Child Guidance Clinic thus creating a closely integrated service. Following diagnostic interview treatment may be carried out at the clinic or occasionally referred for follow-up by the most appropriate agency, e.g. the Child Care Officers, progress being followed up by the Child Psychiatrist. There has been an increasing number of cases requiring treatment at the Child Guidance Clinic as a result of which it was necessary to request the appointment of an additional psycho-therapist. Maladjusted children in need of special schooling are placed either in North Downs Day Special School or in residential schools for maladjusted children. The number of children referred to the Child Guidance Clinic during 1970 was 130 (129). Full details of the work of the Child Guidance Clinic are given in the Appendix to this report. (d) School Psychological Service The London Borough of Sutton differs from the majority of local authorities in that the School Psychological Service was administered by the Department of Health and Family Services and not by the Education Department. This afforded greater opportunity for co-operation with the Health Authority and as a result of this the educational psychologists are already much concerned with the assessment of severely subnormal and pre-school children. Nevertheless by the nature of its work the School Psychological Service is particularly concerned with building a close working relationship with schools and with the Education Department. Close liaison is maintained with the Child Guidance Clinic and psychological reports were submitted to the child psychiatrist in respect of 56 children. At the request of the Chief Education Officer the School Psychological Service devised a questionnaire on remedial teaching facilities which was sent to all primary schools and the results were subsequently analysed and a report submitted to the Chief Education Officer. The psychologists have also assisted in the allocation to high schools procedure by assessing all under-age candidates and have participated in some of the in-service training organised by the Education Department. 33 In addition to the number of children seen for psychometric assessment, 25 sessions of remedial teaching were undertaken during the year and regular counselling sessions introduced in some high schools. In 16 counselling sessions 34 children were seen for one or more interviews. The service has also been responsible for the supervision of students on courses for school counselling and the teaching of maladjusted and handicapped children. We also maintain links with clinical psychologists in the area and have given lectures in Educational Psychology to probationary psychologists for the B.P.S. Diploma in clinical psychology. A table giving full statistical details is in the Appendix to this report. Observation/Diagnostic Classes During 1968 two Observation/Diagnostic Classes were established attached to two primary schools. Each class caters for ten children aged between 5 - 7 years and are staffed by a trained teacher and a school helper. The children admitted to the classes are fully assessed prior to their admission and it is considered that pupils admitted would be unable to progress in a large infants class. Each term a conference is held between the teacher of each class, an educational psychologist, the Principal Medical Officer and Chief Education Officer, to discuss each child's progress and the future placement of each pupil. Up to 31st December, 1970, 45 pupils have been admitted to the two Observation/ Diagnostic Classes. Of these:- 19 transferred to E.S.N. School 1 transferred to Training Centre 2 transferred to Independent School for Emotionally Disturbed Children 1 transferred to North Downs Maladjusted Unit 1 transferred to Partially Hearing Unit 1 transferred to Physically Handicapped School 1 transferred to Residential Open Air School for Delicate Children 18 transferred to Ordinary School The classes have been most valuable since their establishment and have formed an essential part in observing children with handicapping conditions closely in order to ensure that they are recommended for the type of education best suited to their needs. Screening Procedure for inborn errors of metabolism Research has shown that certain handicapping conditions (i.e. mental retardation, disturbed behaviour and epilepsy) can be caused in a small percentage of children by an in-born error of metabolism. In conjunction with Queen Mary's Hospital for Children, screening for these abnormalities was offered to the parents of all pupils attending Carew Manor E.S.N. School, the Training Centre, Day Unit for Maladjusted Children and The Link School, Croydon. 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. 34 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. Table showing full details is in the Appendix to this report. 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, two Observation/Diagnostic Classes, two Autistic Classes and one Class for Non-Communicating Children aged under Five Years. 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 7-16 years. The average number of pupils attending during 1970 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 headteacher or the parents, these examinations can be arranged at short notice at any time. In addition to a regular weekly session at the school by the Senior Medical Officer and educational psychologists, three physiotherapy sessions are held each week and four sessions are devoted to speech therapy. The Teacher for the Deaf also visits regularly. Before a pupil leaves school at the age of 16 years, a full medical and psychological investigation is carried out. A case conference is held during a pupil's last year in the school. The headteacher, Senior Medical Officer, Youth Employment Officer and Social Workers involved with the child all attend, and a decision is made regarding the type of employment or training best suited to the pupil. In addition the the pupils at the school, the conference also discusses all other handicapped pupils in the borough leaving school in that year in order to decide what type of employment or future training they may require. In some cases pupils may not be accepted into employment immediately on leaving school, or may drift from one job to another. In these circumstances a recommendation is made that the pupil should be supervised by social workers, and recommendations are made for the pupil to have future training in a sheltered workshop prior to taking up open employment in the community. To assist in finding suitable employment, the 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, as an increasing number of pupils at ordinary schools are now ascertained to be educationally sub-normal by the age of 6 years. Many children are assessed as being educationally sub-normal earlier since the Observation/Handicap Register came into being. These children have to be found a place in schools in neighbouring authorities. It is hoped in the near future that the Education Committee will make provision for these children to receive education in an educationally sub-normal school in the borough. (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 41/2 days each week. 35 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 with the parents of pupils attending the Unit. The number of new admissions to the Unit in 1970 were 22 (13). (c) Autistic Unit at Queen Mary's Hospital School In September 1970 a class for non-communicating to children aged under five years was established at Queen Mary's Hospital School for supplement the two existing classes. The class for children aged under five years is divided into two groups with usually four children attending the group during the morning or afternoon. The classes are staffed by a full-time teacher and a nurse from Queen Mary's Hospital. Children attending these classesmay either be resident in Queen Mary's Hospital, attend daily from home in the borough and occasionally from other boroughs. It is hoped that by the establishment of the class for very young children their progress and prognosis will be greatly improved by earlier education by experienced staff in their particular handicap. All the classes are attended regularly by a speech therapist, psychologist, psychiatrist and teacher of the deaf. Each term a conference is held attended by all concerned with the children in the classes to discuss their progress and placement. Children are also admitted to the classes for a diagnostic and assessment period. This has proved most helpful in deciding a child's best future placement. No. of children attending Unit 17 (9) No. of children discharged 4 ( 2) No. of children attending Unit who are: (a) long-stay residents in Queen Mary's Hospital 8 (10) (b) from the community 9 ( 2) No. of children transferred from Unit to other classes for autistic children 2 ( 2) During 1970 in addition 3 other children were given short diagnostic trials in one of the classes and they were all found suitable for attendance at one of the classes. (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, 1970 was 145 (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. Many of these children are found to be not suffering from deafness but to be non-communicating 36 (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 teachers of the deaf. (f) Other Hospitals Tuition has also been arranged at the following hospitals:- St. Helier Hospital Children's Unit 15 (13) Royal Marsden Hospital 14 (2) Rutherford Children's Centre 1 (- ) Belmont Children's Unit 11 (10) (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. Home tuition was arranged in 1970 for 6 (8) pupils. Employment of Children of School Age The bye-laws regulating the employment of children provide for their medical examination prior to employment and annual re-examination. No. of children examined during 1970 was 247 (339) Provision of Meals and Milk in Schools The number of day pupils receiving mid-day meals and milk per day both at maintained and non-maintained schools during 1970 was as follows:- Average meals:- Maintained schools 16250 (16035) Non-maintained schools 350 (400) TOTAL 16600 (16435) Average milk:- Maintained schools 10296 (11750) Non-maintained schools 1359 (1345) TOTAL 11655 (13095) 37 ENVIRONMENTAL HEALTH SECTION PART III INDEX Page No. INTRODUCTION 39 HOUSING 41 RENT ACT 1957 42 FOOD AND DRUGS 43 INSPECTION OF FOOD PREMISES AND ACTION TAKEN 49 WATER SUPPLY 50 SWIMMING BATHS 53 SHOPS 53 HAIRDRESSERS AND BARBERS 53 OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 53 FACTORIES ACT 1961 54 CLEAN AIR ACT 1956 56 MORTUARY 58 CARAVANS 58 DISEASES OF ANIMALS ACT 1950 58 FERTILISERS AND FEEDING STUFFS ACT 1926 58 NOISE 58 RAG FLOCK AND OTHER FILLING MATERIALS ACT 1951 59 RADIOACTIVE SUBSTANCES ACT 1960 59 PREVENTION OF DAMAGE BY PESTS ACT 59 LICENCES, PERMITS AND REGISTRATIONS 60 STATISTICS 60 H. GEO. CRIPPS, FRSH., FAPHI., Chief Public Health Inspector 38 In presenting the annual report of the Environmental Health Section for 1970 I am conscious that the resources of the Section have been under considerable pressure due to increased responsibilities and the necessity for maintaining an adequate coverage, by inspection and sampling, of the various groups of premises and the numerous commodities for which the Section has a responsibility. In the field of housing, applications for qualification certificates under the Housing Act 1969 necessitated the complete survey of over eight hundred houses which otherwise would not have been visited and resulted in works being commenced to improve and bring the houses up to a state of good repair. The total number of house inspections for all purposes exceeded seven thousand. Five unfit houses were included in new Clearance Areas and twenty-one in areas previously declared and confirmed were demolished. Three were made the subject of Closing Orders. The impact of this work caused a temporary set back to the routine inspection of food premises, but by the end of the period the majority had been inspected and follow-up visits were being made to those in which an acceptable standard was not being met. Complaints of unsoundness or of foreign bodies in food increased considerably. Every complaint was thoroughly investigated, many with the assistance of the Public Analyst and in others that of laboratory staffs of the manufacturing and processing firms concerned. In sixteen cases the Authority resolved that legal proceedings should be instituted. The sampling of food for chemical and bacteriological examination has not been neglected. The inspection and improvement of premises in which persons are employed continued. These, it is felt, will require regular visits in view of the numerous changes of occupation and numbers of staff employed which occur in a relatively short period of time. The year was a frustrating one in relation to the smoke control programme. The recommendation of the London Boroughs Association that, due to fears of a shortage of solid smokeless fuel, some Orders should be temporarily suspended, although allied to a request that the programme in London should not lose impetus, resulted in a reduction in the finance available for grants in 1971 and in the staff available for the work. It is now virtually certain that the programme completion date will not be achieved. The control of pests was extended to include foxes, consequent upon the Ministry of Agriculture, Fisheries and Food ceasing its former activities against the urban fox. During the year forty-four foxes were killed. Many were found to be affected by mange. The number of complaints of nuisance from squirrels in roof spaces increased. Investigations led to the trapping of a number, and consequent proofing works to prevent re-entry. Some success attended efforts to control feral pigeons. A systematic survey of the area to map ambient noise levels has been completed with the assistance of the student public health inspectors. This will prove of great benefit when investigating complaints relating to new noise sources which may be established in the future. An unsatisfactory feature of the year's work was the disproportionate amount of time expended inpreventing nuisance arising from the encampment on amenity land on the St. Helier Estate, of gipsies and other itinerants occupying caravans and including in their equipment cars, lorries, horses and other animals. In the absence of facilities their presence represented a continuing threat to the amenities and a potential risk to health. It is essential that an adequate and permanent site, equipped with sanitary and ablution arrangements drained to the main sewerage system and suitably serviced, should be provided. Only then will it be possible to take appropriate action to prevent the establishment of further unauthorised caravan sites in the Borough. The lesson to be learned from the year's work is the danger of important routine work being, in part, neglected by the advent of new and immediate duties and problems. To overcome this and to enable the Inspectorate to acquire a deeper knowledge of the many facets of the work, consideration is being given to the establishment of groups or teams of staff each concentrating attention on a particular function but capable of being immediately interchangeable in the event of changing circumstances and periodically subject to reorganisation to ensure that each public health inspector is enabled to maintain his wide knowledge and develop his experience over the whole range of duties which are included in the Environmental Health Service. 39 In concluding, I would express my thanks to every member of the Environmental Health staff for the assistance and support cheerfully available to me throughout the year. H. GEORGE CRIPPS Chief Public Health Inspector 40 Summary of Action taken under the Housing Acts with regard to Unfit Houses Total Number of Properties Affected Clearance Areas Declared 2 5 Clearance Orders Confirmed Houses Demolished in Clearance Areas 21 Individual Unfit Houses dealt with by - (a) Demolition Orders (b) Closing Orders 3 3 Inspection and Action taken under Statutory Powers: Total Number of dwellinghouses inspected for Housing defects (under Public Health or Housing Acts) 7,122 Number of inspections for the purpose 12,151 Number of dwelli nghouses found not to be in all respects reasonably fit for human habitation 790 Number of dwellinghouses in respect of which informal notices were served requiring repairs 790 Number of dwellinghouses in which defects remedied 376 Proceedings under Sections 9, 10 and 12 of the Housing Act 1957: Number of dwellinghouses in respect of which Formal Notices were served requiring repairs 2 Number of dwellinghouses 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 dwellinghouses in respect of which formal notices were served requiring repairs 45 Number of dwellinghouses which were rendered fit after service of formal notices:- By Owners 13 By Local Authorities in default of owners 15 Houses in Multiple Occupation Of the 16 houses inspected in the period, all were found to be houses to which the House in Multiple Occupation Regulations apply. During the period 9 houses were brought up to the standard acceptable to the Council. 41 Housing Act, 1969: Number of applications for Qualification Certificates received 898 Number of applications for Certificates of provisional approval received 25 Number of applications withdrawn/invalid 27 Number of applications deferred pending compliance with requirements relating to defects of repair 567 Number of dwellings where defects had since been remedied 246 Number of inspections made in connection with defects of repair 821 Total number of inspections for all purposes (excluding unsuccessful visits) 1,005 Number of Qualification Certificates issued 395 Number of Certificates of provisional approval issued 8 Number of applications refused 35 Housing Act 1957 - Part IV (Overcrowding) Cases of overcrowding were reviewed during 1970. The information obtained is summarised below:- (a) (1) Number of dwellinghouses overcrowded at the end of the year 6 (2) Number of families dwelling therein 9 (3) Equivalent number of adults dwelling therein 49 (b) Number of new cases reported during the year 2 (c) (1) Number of cases of overcrowding relieved during the year 1 (2) Number of persons concerned in such cases 8 (d) Particulars of any cases in which dwellinghouses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Rent Act 1957 No applications were received under this legislation. Food and Drugs Inspection and Supervision of Food Premises: Inspections 2,449 Notices re unsatisfactory conditions 207 Complaints including those re adulterated and unsound food 271 Legal Action 16 42 Articles of food containing foreign bodies or mould were as follows:- Article Article Alcoholic Drinks 1 Margarine 1 Baby Food 1 Meat 11 Beverage 1 Meat Pies 6 Bread 24 Milk 14 Butter 1 Milk Bottles 10 Cereals 2 (contaminated or chipped) Cheese 5 Preserves 1 Confectionary Flour 9 Sauce 1 Confectionary Sugar 1 Sausages 5 Cordial 1 Shell Fish 1 Cream - Sugar Drugs 1 Soup 1 Fish 2 Tea 1 Fruit 7 Vegetables 3 Yoghurt 2 Unsound Food: The following quantities of food found to be unsound, diseased or unwholesome and unfit for human consumption were surrendered and destroyed:- Unwrapped Food Wrapped Food Number of Containers lbs. ozs. Beverages - - 44 Cereals - - 115 Cheese - - - Condiments - - 2 Confectionary Flour - 3 13,200 Confectionary Sugar 639 0 51 Cream - - 5 Fats and Oils - - 320 Fish 136 8 3,687 Frozen Food 669 0 - Fruit 194 0 198 Fruit Juice - - 137 Ice Cream - - 581 Meat 548 8 114 Meat Canned 72 0 64 Meat Cooked 34 0 488 Milk - - 22 Preserves - - 31 Sauce - - 11 Sausages 29 0 193 Soup - - 23 Vegetables 112 8 3,511 Miscellaneous 382 0 1,424 2,816 11 24,221 43 The following samples were taken for bacteriological examination:- Milk: Classification of the milk samples and the results of the tests are as follows: nation under which sold No. of Samples Methylene Blue Test Phosphatase Test Turbidity Test Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Pasteurised 67 62 5 66 1 - - Ultra Heat Treated 4 4 - 4 - - - Untreated - - - - - - - Sterilised 6 - - - - 6 - TOTAL 77 66 5 70 1 6 - The methlene blue failures were investigated and a further programme of sampling arranged. Ice Cream: Bacteriological examination of ice-cream samples taken were reported upon as follows: Grade I 40 Grade II 7 Grade III 2 Grade IV - Unsatisfactory results were investigated and subsequent reports from the same sources proved satisfactory. Other Foods: Bacteriological examination of 119 items were made during the period. Satisfactory reports were received. Adulteration of Food: The table below is a summary of the total 521 samples of food and drugs which were purchased for examination by the Public Analyst, Mr. J.A. Palgrave, B.Sc., F.R.I.C. Food Samples - Chemical Analysis Satisfactory Adulterated Total Formal Informal Formal Informal Alcoholic Drinks - 1 - . 1 Beverages 2 6 - - 8 Cereals and Cereal Products 6 14 - - 20 Cheese 1 23 - - 24 Confectionery Flour 3 10 - - 13 Confectionery Sugar 3 20 - - 23 Cream - 5 - - 5 Drugs 2 1 - - 3 Carried forward 17 80 - - 97 44 Continued over Continued Satisfactory Adulterated Total Formal Informal Formal Informal Brought forward 17 80 - - 97 Fat and Oils 2 11 - - 13 Fish and Fish Products - 18 - - 18 Fruit and Fruit Products 4 19 1 3 27 Ice Cream 2 1 - - 3 Meat and Meat Products 9 44 2 3 58 Milk 26 22 - - 48 Milk Products 5 24 2 2 33 Preserves 1 14 - - 15 Sausages 11 5 1 - 17 Sauce - 23 - - 23 Soft Drinks 15 20 4 - 39 Soup 1 3 - - 4 Vegetable and Vegetable Products _ 17 . - 17 Miscellaneous 4 100 1 4 109 97 401 11 12 521 The samples described as adulterated or irregular were reported upon by the Analyst as follows and action was taken as indicated:- Informal Sample - Boneless Chicken: The sample was deficient in meat to the extent of 10 per cent. No further stocks were available for formal sampling. Informal Sample - Fruit Salad: Ingredients as declared on the label were not in the order by weight in which they were present in the can, as required by the Labelling of Food Order 1953. The producers were advised and the label revised. Formal Sample - Orange Squash: The sample contained Cyclamic Acid. Cyclamic Acid is an artificial sweetener which is not a permitted artificial sweetener. (The Artificial Sweetener in Food Regulations 1969). The manufacturers and the distributers were advised. Despite arrangements for massive withdrawal of the product known to contain Cyclamic Acid, a few small stocks held by retailers had remained undetected. The remainder of stock was withdrawn. Formal Sample - Blackcurrant Drink: The sample contained Cyclamic Acid. The producers were advised and agreed that the sample came from a retailer's old and undetected stock. Formal Sample - Grapefruit Juice: The ingredients of the article were not specified on the label, as required by the Labelling of Food Regulations 1953. 45 The producers were advised and agreed that the label did not comply with the Regulations. Present stocks were exhausted and new stock would be correctly labelled. Informal Sample - Egg and Cheese Cereal - Instant Baby Food: The proportion of sulphur dioxide present in the sample exceeded the amount which may be present, due to the sugar, by 94 parts per million. No other ingredient may contain sulphur dioxide. (The Preservatives in Food Regulations 1962). Efforts to obtain a formal sample were difficult. The manufacturers' laboratories were carrying out tests of the commodity but could not find any SO2; they were concerned and offered all assistance. A formal sample taken proved to be genuine. Informal Sample - Buttermilk: Buttermilk is a by-product of butter manufacture and normally contains 0.5 to 2.0 per cent butter fat. In the opinion of the Public Analyst the name 'buttermilk' is incorrect and the article should be correctly described as 'cultured skim milk'. Formal Sample - Buttermilk: The Public Analyst stated that the article was prepared by culturing skimmed milk and would be more correctly described as 'cultured low fat milk, buttermilk flavour'. The producers were advised of the Public Analyst's opinion on this product, together with his previous opinion on an informal sample of Buttermilk - that some indication should be shown in the title that this product is made from skimmed milk. See note to further formal buttermilk sample below. Formal Sample - Prime Stewed Steak with Gravy: This sample contained 13.6 per cent gristle, and in the opinion of the Public Analyst the proportion of gristle in an article described as 'prime steak with gravy' should not exceed 5 per cent. The manufacturers took steps to ensure that in future the product did not contain excess gristle. Informal Sample - Virginia Ham and Pork: The opinion of the Public Analyst was that the sample was deficient in meat to the extent of 8.9 per cent. The manufacturers did not agree with the factors used by the Public Analyst on their particular cure, but sales of the product were discontinued. Informal Sample - Strawberry Yoghurt: The article was described as 'Yoghurt Low Fat' in one place on the body of the carton but the description did not appear on the cap. In the opinion of the Public Analyst the words 'low fat' should appear wherever the term 'yoghurt' is used. The manufacturers agreed to revise the printing of containers of this product. Formal Sample - Buttermilk: A further repeat sample where the Analyst's opinion remained - that the article would be more correctly described as 'Cultured Low Fat, Buttermilk Flavour'. The matter was taken up by correspondence with the manufacturing Company and has now been resolved. 46 Formal Sample - Beef Sausages: The sausages were found to contain 300 parts per million by weight of sulphur dioxide. Sulphur dioxide is an added preservative and its presence in sausages without declaration is contrary to the Preservatives in Food Regulations 1962. At the time of purchase of the sausages no notice was displayed in the shop declaring that the sausages contained preservative. Following consideration by the Health and Family Services Committee a warning letter was sent to the retailer. Informal Sample - Liquid Wine Finings: The sample contained 450 parts per million by weight of sulphur dioxide and one per cent isinglass. Gelatine, of which isinglass is a form, is permitted to contain 1000 parts per million of sulphur dioxide (The Preservatives in Food Regulations 1962) and the Public Analyst was of the opinion that the sample should contain no more than 100 parts per million of sulphur dioxide. The manufacturers were advised and stated that they had changed their formula for the finings and will in future use isopropyl alcohol as a preservative, as there are no restrictions against the use of this. Informal Sample - Ground Cinnamon: The sample contained 2.2 per cent acid insoluble ash. The Public Analyst expressed the opinion that the acid insoluble ash content of cinnamon powder should not exceed 2 per cent. A formal sample was taken. Formal Sample - Ground Cinnamon: The sample contained 2.1 per cent sand and siliceous matter. In the opinion of the Public Analyst the sand and siliceous matter should not exceed 2 per cent. In view of the small quanitities involved this result is to be checked by a further range of samples. Informal Sample - Dried Apple Dessert Mix: The Public Analyst found that the sample contained 830 parts per million by weight sulphur dioxide and that the sulphur dioxide was not declared as an ingredient, as required by the Labelling of Food Order 1953. The manufacturers were advised and replied that they were using up old stocks of labels but were gradually bringing all labels into line to comply with the Labelling of Food Regulations 1970. Informal Sample - Pork Sausage Meat: Pork sausage meat must not contain less than 65 per cent of meat (The Sausage and Other Meat Product Regulations 1967) and the Public Analyst reported that this sample was deficient in meat to the extent of 3.8 per cent. A follow-up formal sample taken in January, 1971, proved satisfactory. Further checks will be made. Formal Sample - Chopped Pork: The Public Analyst's opinion was that the article consisted of meat with cereal and that the title on the label was calculated to mislead as to the true nature of the article. The matter is the subject of correspondence with the manufacturing Company. 47 Informal Sample - Tomato Puree: The sample had a markedly bitter taste which, in the opinion of the Public Analyst, is caused by tin when present in amounts greater than 100 parts per million. A formal sample of the product was taken in 1971, which also proved unsatisfactory, and the matter has been taken up with the factory Management in Italy. Informal Sample - Lemon Milk Jelly: In the opinion of the Public Analyst an article described as a milk jelly should be made without water, and the sample contained 35 per cent water. A copy of the Analyst's report was sent to the manufacturers with a request for their comments. Formal Sample - Pepsi Cola: The Public Analyst's report showed that the product had a quality deficiency. The manufacturers investigated and found the reason for the fault was a blockage in the proportioning equipment which affected accurate proportioning of ingredients. The fault was corrected. Imported Food Regulations 1968 Containers with a wide range of spices were examined and some thirty-two samples were taken in 1970. The goods were of a high standard but it was found necessary for the importing company to amend some labels. Sugar confectionary items delivered to a wholesale company were examined and sampled. 48 49 INSPECTION OF FOOD PREMISES AND ACTION TAKEN 1970 • 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 Accumulations removed Bakehouses 5 - . 1 - - - - - 1 - - - - - - Bakers & Confectioners 42 15 - 4 - 2 1 3 1 3 _ _ _ _ _ 2 Butchers 92 66 1 5 3 8 4 1 12 17 - _ 6 1 _ 2 Canteens 91 2 - 1 - 1 - _ 4 9 _ 4 _ _ 1 1 Chemists 44 _ _ _ _ _ _ . . . - - - - Confectioners (Sugar) 167 154 - - - _ _ 4 _ 1 _ _ - 2 - 1 Fishmongers 39 9 - 1 - 2 - 1 6 3 _ _ 1 . - Greengrocers & Fruiterers 96 19 2 1 - 3 3 2 4 6 - _ 1 3 2 2 Grocers & General Stores 176 110 2 2 - 12 7 3 5 6 - 1 1 3 - 2 Licensed Premises 100 7 4 3 - 1 1 - 6 5 _ 2 1 - - Milk Storage Depots 3 - - 1 - - - - - 2 _ - - _ - - Restaurants & Cafes 100 32 4 - 7 5 3 5 11 - 1 2 1 1 7 Factory Food 6 - - - - - - - - - _ _ _ _ _ 1 Stalls & Vehicles Food VARIABLE 1 - - - 4 " " 1 2 - - - 3 - 415 9 23 3 40 21 17 44 66 - 8 12 13 4 18 Registration of Milk Distributors: The number of Milk Distributors registered under the Milk and Dairies (General) Regulations 1959 increased from 79 in 1969 to 85 in 1970. Designated licences in force, under the Milk (Special Designation) Regulations 1963 (as amended) during the year were as follows:- Dealer's (Pre-packed Milk) Sterilised 67 Pasteurised 96 Untreated 24 Ultra Heat Treated 53 Dealer's (Pasteuriser's) 1 Slaughterhouses There are no slaughterhouses in the Borough. Water Supply All houses in the Borough enjoy a piped water supply, the majority of houses being supplied by the Sutton District Water Company. A few houses near the northern boundary of the Borough are supplied by the Metropolitan Water Board, and there are a number of private wells supplying hospitals, factories and a school. The average Fluoride content of the water supplied is 0.1 parts per million. The Sutton District Water Company draws its supplies from deep wells in the chalk at Sutton, Cheam, Carshalton and Woodmansterne, and also a bulk supply from wells at Epsom. The water supplied by the Sutton District Water Company is softened to less than 9° of hardness, Clark's Scale, this being approximately 130 parts per million total hardness. I am indebted to Mr. G.L. Ingham, B.Sc., C.Eng., F.I.C.E., F.I.W.E., Engineer and Manager of the Sutton District Water Company, for the following information relating to 1970:- 1. The total rainfall recorded at Burgh Heath Reservoir during the year 1970 was 827mm. (32.55 ins.) this being an increase of 43mm. (1.67 ins.) when compared with the standard 35-year average of 784mm. (30.88 ins.) 2. The pattern of weather in the early months of 1970 was very similar to that of the preceding year. January was mild but February and March were comparatively cold with some snowfalls experienced in both these months. A moderate snowfall also occurred towards the latter part of December and temperatures generally were low. All the above rainfalls and standard averages refer as in previous annual reports to the records taken at Burgh Heath Pumping Station, as this station is assumed to give a reliable indication of the mean rainfall for the Company's catchment area as a whole. 3. At the commencement of 1970 the underground water levels were relatively low, but increased rapidly during February and March, reaching their peak in April. Underground levels generally were somewhat lower than for the preceding year, which were exceptionally high due to the extreme rainfall experienced in the autumn of 1968. 4. Supply and Consumption - Because of the warm and dry weather experienced during the early summer of 1970 the consumption of water was exceptionally high and broke all previous records. The comparable figures for 1969/70 are as follows:- 50 1969 1970 Average daily consumption 58,105 C.M.D. 58,582 C.M.D. for year (12,783,000 G.P.D.) (12,888,000 G.P.D.) Average daily consumption 79,350 C.M.D. 85,105 C.M.D. during week of maximum demand (17,457,000 G.P.D.) (18,723,000 G.P.D.) Maximum daily consumption 88,000 C.M.D. 98,554 C.M.D. (19.360,000 G.P.D.) (21,682,000 G.P.D.) The maximum daily consumption shown above is the highest for any one day in the history of the Water Company, being 15% higher than the maximum in 1969. The continued and heavy increase in demand for water was brought about almost entirely by the use of hosepipes and sprinklers for garden watering. 5. Population Supplied - The following table gives the estimated population supplied in 1969 and 1970 based on information furnished by local authorities, hospitals and institutions. December 1969 300,538 December 1970 301,040 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 information:- 1. (a) The supply was satisfactory both as to quality and quantity throughout 1970. (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 the analytical 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 your area, but the population supplied direct according to the Registrar General's estimates at 30th June, 1970 was 1,918. (ii) No houses were permanently supplied by standpipe. (d) No artificial fluoride is being added, and where the fluoride conient is indicated in the analyses it represents the naturally occurring fluoride in the water. 2. (a) The supply was derived from the following works and pumping stations - River Thames - derived water from Hampton, Walton and Surbiton, and well water from Merton pumping station. 51 No new sources of supply were instituted and there were no changes to the general scheme of supply in your 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:- Bacteriological Results Yearly 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 100ml. Per cent samples negative in 100ml. River Thames derived 3,710 8.0 99.92 99.97 Merton Abbey 8 0.0 3 100.0 100.0 Average Results of the Chemical Examination of Water (Milligrames per litre (unless otherwise stated)) River Thames Merton Abbey River Thames Merton Abbey No. of Samples 363 3 Chloride as C1 40 16 Ammoniacal Nitrogen 0.026 0.015 Phosphate as PO4 2.7 Albuminoid Nitrogen 0.083 0.021 Silicate as Si02 9 Nitrate Nitrogen 4.8 0.8 Sulphate as SO4 70 Oxygen abs. from KMn04 1.02 0.12 Natural Fluoride as F 0.20 0.50 Hardness (total) CaCOg 274 244 Surface-active material as Manoxol OT 0.03 Hardness (noncarbonate) CaCOg 79 22 Turbidity Units 0.1 0.3 Magnesium as Mg. 5 Colour (Burgess units) 11 6 Sodium as Na. 27.7 pH value 7.9 7.3 Potassium as K. 5.6 Electrical Conductivity (Micromhos) 570 480 (b) On account of their hardness content and alkaline reaction the Board's river and well water supplies are shown to be not plumbo-solvent. It should, however, be appreciated that alf 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. Water Forty-six samples of water taken by the Public Health Inspectors were reported as satisfactory. 52 Swimming Baths Visits were made to the three public swimming baths and seven school pools during the period. Twenty-six samples in 1970 of water were submitted for bacteriological examination. Checks for pH value and free chlorine were made. The close co-operation which exists between the Borough Engineer, the Chief Education Officer and this department is much appreciated. Shops There were 1,665 shop premises in the Borough and inspections were made during the year under the Shops Acts and the Offices, Shops and Railway Premises Act 1963. Following the failure of persuasive efforts to induce a local trader to comply with the Sunday trading restrictions legal proceedings were taken. The Court sympathised with the trader, who entered a plea of guilty and was fined £1.00. No costs were awarded. Hairdressers and Barbers The Council adopted on the 4th April, 1968, the provisions of the Greater London Council (General Powers) Act 1967 insofar as they relate to the registration of Hairdressers 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 Act. 137 premises were registered. Inspections to ensure compliance with bye-laws requirements have been made. Offices, Shops and Railway Premises Act 1963 31 premises were registered in accordance with the Act, making the total number 1,372. 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 Offices 456 6,819 Retail Shops 818 4,837 Wholesale Shops Warehouses 20 365 Catering Establishments & Canteens 75 663 Fuel Storage Depots 3 23 Preliminary notices were served relating to non-compliance with the Act in respect of the following:- 53  Notices Served Complied (incl. Notices served in 1969 Overcrowding - - Ventilation 2 5 Cleanliness 13 7 Temperature (incl. thermometers) 29 22 Lighting 5 5 Sanitary Conveniences 14 12 Washing Facilities 8 6 Water Supply 10 7 General Conditions 12 - Stairs/Passages 3 4 Clothing Storage - 8 Drying Facilities 6 4 Seats 1 1 Machinery - - First Aid Equipment 36 22 Notices 56 50 Canteen Facilities - - Factories Act 1961 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) (i) Factories in which Sections 1, 2, 3, 4, & 6 are to be enforced by Local Authorities 38 40 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 545 156 5 - (iii) Other premises in which Section 7 is enforced by the Local Authority 33 16 - - * (excluding outworkers' premises) 616 212 5 - *Electrical Station (Section 123(1)), Institutions (Section 124) and sites of Building Operations and Works of Engineering Construction (Section 127) Slaughterhouses (Section 175( 1)(d) and (e)) and Railway Running Sheds (Section 175(2) and (10)). 54 Cases in which Defects were 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) Want of cleanliness - 1 - - - Overcrowding - - - - - Unreasonable temperature - - - - - Inadequate ventilation 2 1 - - - Ineffective drainage of floors - 1 - - - Sanitary Conveniences:- (a) Insufficient - 2 - - - (b) Unsuitable or defective 3 1 - 3 - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to Outwork) 4 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) Wearing apparelmaking etc. 59 - - - - - Boxes (Cardboard) 50 - - - - - Brass and Brass Art 1 - - - - - Curtain making 3 - - - - - Toys 1 - - - - - Flowers 2 - - - - Umbrellas 9 - - - - - Lampshades 19 - - - - - 144 - - - - - 55 Clean Air Act 1956-Smoke Control Areas Smoke Control Orders Nos. 21 and 22 were confirmed during 1970. The date of confirmation of these Orders by the Minister of Housing and Local Government and their operative dates were as follows:- Area 21-confirmation date-21st May, 1970 -operative date-1st July, 1971 Area 22-confirmation date-21st May, 1970 -operative date-1st September, 1971 At the end of the year 4,071 acres were covered by Smoke Control Orders and 32,265 dwellings were affected. Difficulties were expected by the Government and the Solid Smokeless Fuel producers with regard to the availability of smokeless fuels during the winter of 1970/71. Circular 63/70, from the Minister of Housing and Local Government, asked Local Authorities to look into smokeless fuels availability in their areas. It was not thought that suspension of Smoke Control Orders was necessary in Sutton but after a recommendation from the London Boroughs Association it was decided to suspend 40% of the operative Smoke Control Orders from the 1st December, 1970, to the 31st March, 1971. The Orders suspended were Carshalton Nos. 1, 2, 3 and 4, and Beddington and Wallington Nos. 1, 2, 3 and 4, which were the first Smoke Control Orders made in the Borough. The numbers involved were 14,961 premises and an acreage of 2,300. At the end of 1970 five complaints had been received with regard to the inadeauacy of fuel supplies, all of which were resolved with or without the aid of the National Coal Board. No appreciable difference has been noticed in the Volumetric Readings of smoke and sulphur-dioxide. Smoke Control Order No. 24 has been referred to the Council with a proposed operative date of 1st December, 1971, and a survey of Area No. 23 was commenced at the end of the year. 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 reading for the three stations are set out as follows:- 56 LONDON BOROUGH OF SUTTON SUMMARY OF AIR POLLUTION MEASUREMENTS FOR 1970 STATION:- 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 110 337 07 24 31 97 187 321 14 26 50 117 151 373 12 27 40 103 FEBRUARY 72 255 06 24 29 105 116 299 12 20 48 115 84 256 11 28 42 116 MARCH 43 217 06 39 22 106 91 286 11 44 43 136 68 244 10 41 32 112 APRIL 50 205 05 28 17 75 75 237 04 29 16 85 54 166 07 32 22 73 MAY 45 153 05 33 20 79 44 213 08 25 22 92 53 189 10 24 26 84 JUNE 35 215 03 17 14 87 51 211 05 25 20 108 50 229 07 17 20 80 JULY 17 96 03 13 07 33 24 115 05 11 11 35 28 69 06 11 12 25 AUGUST 26 156 03 18 13 59 38 216 06 23 16 78 29 166 08 16 17 58 SEPTEMBER 34 82 04 19 14 45 37 136 02 14 10 40 39 118 05 13 14 43 OCTOBER 64 173 03 18 17 65 96 164 04 12 30 62 98 171 08 15 29 63 NOVEMBER 54 102 04 19 13 47 84 110 06 26 23 49 86 151 08 16 22 46 DECEMBER 74 480 - 31 130 215 429 15 35 57 133 225 525 16 37 54 129 ALL FIGURES IN MICRO-GRAMMES PER CUBIC METRE (MILLIONTH) 57 Mortuary The Council maintains a mortuary at Alcorn Close, Sutton Common Road, Sutton, which is equipped with refrigeration storage and facilities for post-mortem examination. The number of bodies, on all of which autopsies were performed, admitted during the year was as follows:- From local hospitals 177 From homes within the Borough 227 Other ambulance removals 115 519 Other Matters Caravans At the beginning of the year the number of unauthorised caravans parked in the area was 4. This number had increased to 25 by the end of the year. The operative date of the Caravan Sites Act 1968 was 1st April, 1970, when it became the responsibility of the Authority to provide a caravan site for travellers. A survey was carried out at the beginning of each month during the year to ascertain the movement of caravan dwellers in and out of the area. The Borough Architect and Planning Officer was requested by the Council to find a suitable site for caravans within the Borough and, after a considerable time, a site for fifteen vans was chosen at Carshalton Road, Woodmansterne. It is hoped that this site will be occupied during the early part of 1971. During the year temporary facilities were provided for unauthorised caravan dwellers on the St. Helier Estate in the form of refuse skips on the site and the provision of a sludge tank for the disposal of the contents of pail closets. The unauthorised parking of caravans on the St. Helier Estate during the year caused some difficulty because of numerous complaints from members of the public but although regular inspections of the sites were carried out by Public Health Inspectors, no nuisances were found. No efforts were made by this department to move the caravans as, after the operative date of the Caravan Sites Act 1968, this Council adopted a policy of non-harassment. 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. Fertilisers and Feeding Stuffs Act 1926. 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. Four informal samples were taken under this Act during the year, of which two were found not to be within the prescribed limites of variation. The two samples in question will be followed up by formal samples in 1971. Noise 53 complaints with regard to noise were received from members of the public during the year, all of which were brought to a satisfactory conclusion without statutory action. 58 An ambient noise level survey has been carried out in the Borough during the year, with noise level readings being taken during every hour of the day at 20 sites. Variations in ambient noise levels appear to be due mainly to traffic noise and possibly in some instances to aircraft noise. Rag Flock and Other Filling Materials Act 1951 The prescribed Analyst is Mr. G.E. Green, B.Sc., A.R.I.C., British Standards Institute Centre, Maylands Avenue, Hemel Hempstead, Herts. Two samples taken during the period satisfied the requirements. 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 Act:- 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. 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 Radioactive Waste: Radiological Protection Service, Clifton Avenue, Belmont. Royal Marsden Hospital, and the Institute of Cancer Research, Downs Road, Belmont. Prevention of Damage by Pests Act 1949 Complaints of rat and mouse infestation 1,491 Infestations found on survey (not subject of complaint) 90 Premises found to be infested 1,349 Informal Notices under Section 4 of the Act 3 Wasps Complaints received 653 Nests treated 553 Other Pests Destroyed Foxes 44 Squirrels 122 Pigeons 141 Destruction of land pests was undertaken by the Local Authority when the Ministry of Agricultural Pest Officers ceased to be able to provide practical assistance. 59 Licences, Permits and Registrations The following licences, permits and registrations existed at 31st December, 1970:- Animal Boarding Establishments Act 1963-Licences 5 Betting, Gaming and Lotteries Act 1963 - Small Lotteries- Registrations 121 Diseases of Animals (Waste Foods) Order 1957-Licences (Personal Once Only) 19 Game Act 1831-Game Dealers' Licences 19 Gaming Act 1968 - Amusement Machines-Permits (3 year period) 31 Greater London Council (General Powers Act 1967) Hairdressers and Barbers-Registrations (Personal once only) 137 Late Night Refreshment Houses Act 1969 3 Milk (Special Designation) Regulations 1963- Licences (5 year period expiring 31.12.70) 241 London Government Act 1963-Employment Agency Licences 21 Surrey County Council Act 1931 (Part IV)-Massage/Special Treatment Establishment Licences 19 Moneylenders Act 1927-Moneylenders Licences 5 Greater London Council (General Powers) Act 1968 - Night Cafes-Registrations 4 Pet Animals Act 1951-Licences 13 Pharmacy and Poisons Act 1933-Sellers of Part 11 Poisons - Registrations 123 Rag Flock and Other Filling Materials Act 1951 - Registrations (Once Only) 4 Riding Establishments Act 1964-Licences 2 Theatrical Employers Registration Act 1925 and 1928 - Licences (Personal Once Only) 38 Scrap Metal Dealers Act 1964-Registrations (3 year period) 16 Slaughter of Animals Act 1958-Licences 1 War Charities Act 1940 and National Assistance Act 1948 - Registrations (Once Only) 8 Statistics Investigations were made with regard to 5,214 complaints, as follows:- Accumulations 77 Animals kept in unsatisfactory conditions 23 Cellulose spraying 6 Clean Air-contraventions 96 Dampness 86 Dirty conditions 34 Drainage defects 35 Drains obstructed 1,888 Dustbins 8 Flooding and Water Accumulations 11 Food contaminated 159 Food unsound 112 Fouling of footpaths 24 Housing-General defective conditions 48 Insects and pests 328 Miscellaneous 74 60 Noise 53 Obnoxious Effluvia 198 Overcrowding 1 Overgrown gardens 23 Public conveniences 4 Refuse collection 206 Rivers 4 Rodents 1,491 Roofs defective 24 Shops Act contraventions 1 Sink Waste Pipes 5 Tents, Vans, Sheds 21 Verminous Premises 86 Water Supply 5 Thirty-four thousand, nine hundred and nineteen surveys, inspections, visits and re-visits were made for the purposes set out below:- Animal Boarding Establishments 6 Clean Air Act 10,794 Diseases of Animals Act 15 Employment Agencies 23 Establishments for Massage and Special Treatment 18 Factories (Mechanical Power-incl. Laundries) 156 Factories (non-Mechanical Power) 40 Factories (Building Sites) 16 Fertilisers and Feeding Stuffs 8 Food & Drugs (incl. Sampling, Unsound Food etc.) 1,765 Food Premises Bakehouses 47 Bakers & Confectioners 135 Butchers 327 Canteens 42 Canteens-Schools 26 Chemists 41 Confectioners (Sugar) 194 Factory Food 6 Fishmongers 110 General Stores 201 Greengrocers & Fruiterers 269 Grocers 425 Ice-Cream Factories 1 Ice-Cream Vehicles 34 Licensed Premises with Catering Facilities 67 Licensed Premises without Catering Facilities 39 Milk Storage Depots 17 Restaurants and Cafes 380 Stalls, Food 52 Vehicles, Food 36 2,449 Hairdressers 248 Housing Act 4,129 Housing (Land Charges Enquiries) 182 Infectious Disease Premises (incl. food poisoning enquiries) 1,741 Insect Pests 1,726 Merchandise Marks Act 63 Noise 12 Night Cafes 357 Offices, Shops and Railway Premises Act 1,420 Outworkers Premises 38 Pet Animals Act 7 Pharmacy and Poisons Act 2 Piggeries 61 Premises re cesspools 24 Public Control 2 Public conveniences 204 Public Health Act 7,122 Public Health Act (Re infectious) 1,075 Rag, Flock and Other Filling Materials Act 3 Rent Act 8 Riding Establishments Act - Rivers, Ditches and Ponds 49 Rodents 778 Schools 32 Shops 251 Water sampling 83 Work Places 73 34,919 Five hundred and eleven notices were served concerning the following matters:- Accumulations and Deposits 14 Animals kept in unsatisfactory conditions 1 Clean Air Act 1 Drainage Defects 48 Dustbins 3 Factories Act 5 Food and Drugs Act (including Food Hygiene) 207 General Defective Conditions 124 Housing Act (unfit houses) 18 Noise 1 Offices, Shops and Railway Premises Act 84 Prevention of Damage by Pests Act 3 Shops Act 1 Water Supply 1 511 Formal notices were served under the following Acts:- Public Health Act 1936-Section 24 16 Public Health Act 1936-Section 39 9 Public Health Act 1936-Section 93 25 Public Health Act 1936-Section 277 1 Public Health Act 1961-Section 17 1 Public Health Act 1961-Section 26 1 Housing Act 1961-Section 15 2 Housing Act 1957 - Section 159 9 Housing Act 1957 - Section 170 16 The following work was carried out in Houses as a result of notices served:- Accumulations removed 49 Brickwork repaired 2 Ceilings repaired and/or made good 18 Chimneys and flues repaired 8 Damp conditions remedied 50 Doors and frames repaired including locks and fasteners 12 Drainage repaired and/or reconstructed (houses) 23 Drainage inspection chambers repaired 23 Soil pipes renewed 5 62 Drains cleared 1,538 Waste gullies repaired, renewed or provided 9 Waste pipes repaired, renewed or provided 10 Surface water drainage provided or repaired - Dustbins provided 10 Fireplaces, ranges or stoves repaired or renewed 1 Floors renewed or replaced 23 Food Storage accommodation provided 1 Roofs repaired and made weatherproof 47 Downpipes, guttering repaired and/or renewed 30 Stairs repaired 5 Sinks renewed 2 Walls repaired 1 replastered and/or repaired 33 Cleansed and redecorated 2 Wash basins and baths provided 4 Water supply renewals or repairs 10 W.C. provided 1 W.C. accommodation repaired 5 W.C. pans and seats repaired, renewed or provided 10 flushing apparatus repaired or renewed 22 Windows repaired and/or renewed 35 Ventilation provided 7 63 SOCIAL SERVICES DIVISION PART IV (NATIONAL ASSISTANCE ACTS) (CHILDRENS ACTS) INDEX Page No. INTRODUCTION 65 THE CHILDREN'S SERVICE 65 WELFARE SERVICES FOR THE PHYSICALLY HANDICAPPED 65 EMPLOYMENT AND FACILITIES FOR WORK FOR THE DISABLED 67 VISITS BY SOCIAL WELFARE OFFICERS 67 TRANSPORT 67 PART-TIME CLUBS FOR THE DISABLED 67 DISABLF.D DRIVERS 68 HOLIDAYS FOR THE HANDICAPPED 68 WELFARE OF THE BLIND AND PARTIALLY SIGHTED 68 SERVICES FOR THE ELDERLY 72 TEMPORARY ACCOMMODATION-HOMELESS FAMILIES 73 W. FRANCE, ACIS., AISW. Director of Social Services 64 The most significant event in the year under review was the passing of the Local Authority Social Services Act, 1970, bringing with it the statutory appointment of a Director of Social Services and the acceptance of the philosophy of the Seebohm Report on the future pattern of social services throughout the borough. As from 1st January, 1971 a Social Services Committee was formed and steps taken toward the formulation of the new Social Services Department under the newly appointed Director. The former Social Services Division of the Health and Family Services Department, together with the Mental Health Section and the Home Help Service, and certain other responsibilities connected with the Registration of Day Nurseries and Daily Minders, were all gathered together and the Social Services Department created, legally at least - if not in fact - as from 1st April, 1971. The proposed structure and organisation of the new department was accepted by the Council on the 11th May, 1971, and it is hoped that its operation will not be too long delayed. Together with the Local Authority Social Services Act, the Social Services Department faces the heavy demands of the Chronically Sick and Disabled Act, the Children and Young Persons Act 1969, and the now operative parts of the Public Health and Health Services Act of 1968. All these statutes mean an extension in the caring services for all our clients, and call for the allocation of further resources over the years ahead. I am hoping that together with our colleagues in the voluntary organisations, we will, in due course make comprehensive social services a reality in the borough. The Children's Service During the period under review, sections of the Children and Young Persons Act 1969 have been implemented and the number of child care officers in the department has been increased in order to deal with the increase in referrals from the courts and other agencies. This has resulted in the reduction of officers' case loads to an average of fifty overall. A significant change in the service brought about by the Act has been that children's homes, remand homes and approved schools, have been redesignated community homes, and regional planning committees were set up to study the needs for residential provision during the next five years. The London Area constitutes Regional Planning Area 8 which has been divided into three sub-committees, the London Borough of Sutton being one of eleven boroughs south of the Thames which form one sub-committee-one of the senior child care officers has attended all the meetings and provided the statistics and projections required. The Chairman and ViceChairman have attended the meetings of the full committee. The number of children received into care has increased - especially those requiring short-term care, but due to the recruitment of new foster parents and the continued support of established foster parents, the percentage of children boarded out has been maintained. In accordance with the council's recommendation, negotiations were entered into with the Home Office for the transfer of Dean House Children's Home, Merstham to 8, Stanley Park Road, Wallington, and the Borough Architect submitted plans which have been accepted and loan sanction approved. Work will commence on the necessary extensions in 1971-72 and the children and staff will transfer to this house in Wallington, which will ultimately provide accommodation for 12 children and better facilities for children and staff. Welfare Services for the Physically Handicapped-General Classes Local Authorities are statutorily required to provide welfare services for the handicapped (general class) and the deaf and hard-of-hearing. The duty imposed on the local authority requires that persons to whom the arrangements relate are informed of services available to them. The services available include provision of work shops where such persons may be engaged in suitable work; providing handicapped persons with suitable work in their own homes and helping such persons to dispose of their work. The local authority may also provide handicapped persons with recreational facilities within their homes or elsewhere. 65 With the Chronically Sick and Disabled Act 1970 appearing on the statute book, the local authorities are required to extend their facilities for the handicapped and greater pressures than heretofore will be placed on existing services. The local authorities are also required to maintain a register of handicapped persons and the following statistics set out the grouping of disabilities:- The number of registrations during the year 1969 was 114 bringing the total number of registered disabled people to 1,082, during 1970, the number of registrations was 248; the total number of registered physically disabled people, 1167. As to the manner in which handicapped people have either voluntarily come forward or been referred for registration is demonstrated:- No. of handicapped people on the register 31.12.69 1,082 No. of removals and deaths 163 No. of newly registered handicapped persons 248 No. of persons on register at 31.12.70 1,167 and the extract of statistics from the statutory register shows the following classifications: Classification of Disabilities and age groups Disability Under 16 16-29 30-49 50-64 65+ Total at 31.12.70 Total at 31.12.69 Amputation - 2 2 20 30 54 43 Arthritis - 2 19 81 315 417 383 Congenital malformation 6 8 6 1 4 25 21 Digestive and Heart - 4 6 45 83 138 129 Injuries 1 4 9 18 45 77 78 Organic ND 13 47 83 126 116 385 360 Neurosis - 1 3 5 6 15 14 T.B. Resp. - 1 1 6 4 12 9 T.B. Surg. - - 3 2 5 10 10 Any other - 4 3 7 20 34 35 20 73 135 311 628 1,167 1,082 Deaf Under 16 16-29 30-49 50-64 65+ Total at 31.12.70 Total at 31.12.69 Deaf with speech 2 7 6 - 11 26 34 Deaf without speech 1 1 6 3 2 13 26 Hard of hearing < . 2 3 2 30 37 60 3 10 15 5 43 76 120 66 Employment and facilities for work for the disabled So far as employment is concerned, the registered handicapped persons fall into the following groups:- 1. Capable of normal employment 112 2. Capable of sheltered employment in accordance with definition of Ministry of Labour 48 3. Capable of some work or part-time work in very sheltered conditions (e.g. Work Centre) 114 (a) attendance at Work Centre 64 (b) receiving outwork and/or occupational therapy 50 4. Not available for work 867 5. Under 16 years of age 26 The Work Centre in Mulgrave Road, Sutton, has, with the increase in the numbers requiring this service, became overcrowded and is working to capacity. Within the financial estimates there is provision for a new Work Centre and Adult Training Centre. A site is being sought for this and it is hoped that the building may be ready during the year 1972/73. Visits made by social welfare officers from 1st January, 1970 to 31st December, 1970 Visits made in connection with handicapped social work and registration 3,112 Visits made in connection with escort duties to and from the work centre 110 Visits made in connection with adaptations 255 Visits made in connection with occupational therapy 984 Visits made in connection with occupational therapy at Brambleacres 14 Visits made in connection with occupational therapy at Maiden Homes 26 Visits made in connection with occupational therapy at Franklin House 40 Aids to daily living:number of aids issued on loan during the year 1970 514 Adaptations Adaptations have been carried out in the homes of 82 handicapped persons during the year at an approximate cost of £2,107. Transport The ambulance service has been fully stretched throughout the year coping with the task of conveying persons to and from the work centre for the physically handicapped each day and the Spastics Work Centre at Croydon. In addition, the vehicles are regularly used for the transport of handicapped persons to the Red Cross Club afternoon meetings and to other clubs for the handicapped whose meetings are held in the evenings. It is not possible to meet all requests for transport due to vehicles being repaired or drivers sick or on leave. Part-time clubs for the disabled There are 13 known part-time clubs for the handicapped operating throughout the borough and these are very popular with the disabled. As stated in the preceding paragraph, assistance in conveying handicapped persons to and from the clubs is provided by the welfare ambulance type vehicles wherever it is physically possible to do so. 67 Disabled drivers In accordance with the Ministry regulations, disabled drivers windscreen badges have been issued by this department as follows:- No. of badges issued at 31.12.69 126 No. of removals since 31.12.69 5 No. of new badges issued since 31.12.69 29 Total number of car badges issued at 31.12.70 150 Holidays for the handicapped After circulating all registered handicapped persons, the final holiday arrangements for 1970/71 were as indicated below: Centre Handicapped Persons Blind Persons Escorts Hayling Island 76 10 14 Lulworth Court 9 - - Grange Farm 6 - - Crabhill House 2 - - Total number of persons and relatives to be assisted with holidays 153 Estimated cost to the borough of this project in the year under review £2,000 Welfare of the Blind and Partially-Sighted As in previous years, the annual return submitted to the Department of Health and Social Security on 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 as at 31.12.70 was:- Blind 376 Partially-Sighted 94 Corresponding figures at 31.12.69 Blind 378 Partially-Sighted 97 Table 1-Age Periods of Registered Blind and Partially-Sighted Persons BLIND PARTIALLY-SIGHTED 1970 0-4 5-15 16-49 50-64 65+ Total 0-4 5-15 16-49 50-64 65+ Total Males 1 2 18 21 96 138 - 8 17 6 13 44 Females - 1 15 25 197 238 - 3 10 2 35 50 Total at 31.12.70 1 3 33 46 293 376 - 11 27 8 48 94 Of the 376 blind persons, 50 had other defects, e.g. this number includes 16 who were physically handicapped, 8 who were mentally handicapped, 15 were hard of hearing, 6 were deaft, and one deaf without speech. Four had multiple defects in addition to blindness, e.g. one being mentally handicapped, physically defective and deaf without speech; two physically defective and hard of hearing, and one mentally and physically handicapped. Most of these doubly handicapped persons live at home and are made the subject of special and frequent visits by the social welfare officer for the blind. 68 TABLE 2 Notifications of suspected blindness are received in the period under review for whom examinations were arranged with consultant ophthalmologists, yirelded the following results:- Notification from Total Certified Blind Certified P/S Found not to be Blind or P/Sighted Re-exams Department of Health and Social Security 4 3 1 Relatives 11 7 2 2 Social Welfare Officers 7 5 1 1 Gen. Practitioners 6 2 3 1 Hospital (BD8's direct) 25 14 11 Voluntary agencies 3 3 District nurses/ health visitors 7 3 2 1 Re-examinations 10 10 Totals 73 37 20 6 10 TABLE 3-Movement on Blind and Partially-sighted Registers Blind Register Partially-sighted Register Total number on register 31.12.69 378 Total number on register 31.12.69 97 During the period under review there were: During the period under review there were: Additions Additions As a result of ophthalmic examinations 37 As a result of ophthalmic examinations 20 Partially-sighted persons found to be blind on re-examination 9 Persons moving into borough 3 Persons moving into borough 15 61 61 23 23 439 120 Deductions Deductions Blind persons deceased 50 Partially-sighted persons transferred to Blind Register 9 Blind persons removed from borough 13 Partially-sighted persons deceased 12 63 63 Partially-sighted removed the borough 5 26 26 Total number of blind persons on register at 31.12.70 376 Total number of partially-sighted persons on register at 31.12.70 94 69 TABLE 4-Blind and partially-sighted persons registered as new cases (excluding re-certification and transfers in from other areas) during period under review:- Age at date of registration Years 0-4 5-15 16-29 30-49 50-64 65-69 70-79 80-84 85-89 90+ Total Blind Male 1 - - 1 - 1 3 6 2 - 14 Female - - - - 2 2 9 8 4 7 32 Total 1 - - 1 2 3 12 14 6 7 46 Partially Sighted Male 1 2 1 - - 2 - 1 1 - 8 Female - 1 - - - 2 4 2 2 1 12 Total 1 3 1 - - 4 4 3 3 1 20 TABLE 5-Education, Training and Employment of Blind and Partially-sighted persons Blind Children receiving education Open industry In workshops (sheltered) Homeworkers scheme Male 1 17 1 4 Female 1 6 - 2 Total 2 23 1 6 Partially-Sighted Male 8 17 - - Female 3 6 - - Total 11 23 - - In order to enable members to have some idea of the variety of occupations carried out in open and sheltered employments, the following tables are set out. Blind No. of employees Occupation No. Occupation No. Occupation 1 Basket maker 1 Piano teacher Teacher of dancing 2 Physiotherapists 1 Chair caner 1 total 6 Workshop employee 1 Operative in soap factory total 1 Employed in open industry 1 Physiotherapist 1 Builder (own business) 2 Typists 1 Social Welfare officer 2 Shorthand typists 2 Tel. operators 1 Consultant (engineering) 1 1 Kiosk manager Packer 4 Assemblers 1 Shopkeepers 1 Carpenter 1 Storekeeper 3 Factory operatives total 23 70 PartiallySighted No. of Employees Occupation No. Occupation No. Occupation Employed in 7 Factory operatives 1 Master Builder 1 Nurseryman open 2 Tel. operators 1 Pastry-hand 2 Clerical workers industry 1 Physiotherapist 2 Cleaner 1 Receptionist 1 Kiosk manager 1 Electrician 2 Packers 1 Laundryhand Total 23 The fortnightly Handicraft Class held at Highfield Hall continues to be very well attended and undoubtedly fills a great need. There is still a great need for more transport facilities in this respect. Wireless for the Blind The department acts as agents for this Fund and 30 new sets were received and distributed to blind persons during 1970. Many of the older sets in need of repair were put in order free of charge by the members of the Carshalton Technical College and were redistributed. There are some 300 radio sets on loan to blind persons in the district. Some 100 wireless licence exemption certificates were issued during the period under review. Talking Books for the Blind There are approximately 200 of these Talking Book machines on rental to blind persons throughout the district and of this number 60 rentals of £3 per annum is paid by the Social Services Committee on behalf of those blind persons in receipt of social security allowance. In addition to this, a grant is also made to the National Library for the Blind in respect of 25 blind readers who regularly obtain books in Braille or Moon from this source. £5 per annum per reader is paid for this service. Concessional Travel Tickets for the Blind 400 concessional bus tickets were distributed by the Blind Welfare Section during November and December for use of blind persons and their guides on the Green and Red buses. These tickets are valid for 3 years. Railway ticket vouchers are issued where necessary for blind persons (with guides) undertaking train journeys for a specific reason, i.e. attending a London hospital for examination of the eyes, or a blind child being taken to a special school/or school holidays to allow his parent to travel to meet and bring him home. Aids and Equipment A stock of aids for the blind and partially-sighted is held in the Town Hall and sold as and when required. This stock includes white sticks, rules and measures, all card games, puzzles, dominoes, and chess outfits, self-threading needles, and many other aids and pieces of equipment designed specially for the blind. These are all purchased at concessional rates and many of the above articles are bought by the Sutton Association for the Blind and issued free through this department. Holidays for the Blind There is a steady increase of blind persons going on holiday and this year 100 registered blind and partially-sighted persons and their guides were assisted with holiday arrangements. Forms of application were completed here and forwarded to the various blind associations who run hotels and homes in different parts of the country. In many cases the fees for these holidays are received in the Social Services Department and forwarded to the appropriate blind associations. Two weeks before the actual holiday, medical certificates are obtained by this department and again forwarded to the associations concerned. Travelling arrangements are worked out and in many cases transport to the local railway station is provided by voluntary drivers. 71 Each blind or partially-sighted person who is registered and arranges to take a holiday, and is in need of financial assistance, may claim a grant of £6 (or more - the option resting with the social welfare officer for the blind) which the Sutton Association for the Blind kindly donates. These grants are distributed by the social welfare officers for the blind. The sum of £420 was spent by the Sutton Association for the Blind during the period under review. A small party of blind people join in with the Hayling Island holiday project for the physically disabled of the borough. Sutton Association for the Blind This Association continues to give every assistance to the department in all matters pertaining to welfare for the blind. In addition to the £420 spent on holiday grants, donations amounting to the sum of £192 were given to the purchasing of electric fires for needy blind persons, re-decoration of rooms and clearing and maintaining gardens, payment of telephone bills and for a 42 year old blind woman who has just completed a course of rehabilitation, a typewriter has been bought to enable her to become proficient enough to take a post as a typist. At Christmas time, this Association has regularly donated £1 per person for those who are housebound, or in hospital and this year £91 was spent on presents in this way, these presents being wrapped and distributed from the Blind Welfare Section of my department. I would like to express my sincere thanks to the Sutton Association for the Blind for their good work in the field of Blind Welfare. Services for the Elderly A fourth home for the elderly, Bawtree House, Worcester Road, was opened in May 1970. This is situated in the garden of Brambleacres', the land for which was donated by the late Miss Bawtree after whom the house was named. It offers a home for 48 men and women who have settled well; the voluntary League of Friends of Brambleacres have widened their interests to include this new home. Borough residential old people's homes Waiting list at beginning of year 1.1.70 125 Waiting list 31.12.70 137 Number of beds available- Brambleacres 41 Maiden Homes 111 Franklin House 50 Bawtree House 48 St. Anne's, Redhill 36 286 A new home in Benhill Avenue is being built which will accommodate 47 people; it is expected to open in January 1972 and it is hoped it will soon become part of the community as has Franklin House on Roundshaw. Standard Charges for Accommodation This standard rate of maintenance in old people's homes administered by the borough for the year ended March 1970 was £13. 17s. 8d. per week. 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 the voluntary organisations. These homes provide accommodation for old people and offer a further choice to those of a particular sect or religious persuasion to enter into their own particular residential care unit. Financial 72 ments 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 26 registered private old people's homes offering accommodation for 356 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 old people's voluntary welfare committees has been maintained : the number of meals on wheels distributed and served has been increased - also the number at luncheon clubs. The two day centres (Oaks Way, Carshalton and Sutton Lodge, Brighton Road, Sutton), flourish and help many people to continue living in their own homes - transport being provided on a limited basis to take people there. 68,933 meals were served to the housebound : 32,035 meals were served in clubs and centres. Temporary Accommodation-Homeless Families Rehabilitation work amongst families in temporary accommodation and rehabilitation units has continued during the year, but the demand upon the services caring for homeless families has in no way lessened, and whilst the department's resources by way of accommodation have always measured up to the demand, there have been occasions when, with no leeway available for any sudden emergency, the department has been in some danger of not being able to carry out its statutory functions. Occasionally, voluntary hostels have been used, and on one occasion at least accommodation had to be offered in what is normally living accommodation for residential staff of one of the old people's homes. The council's policy of preventing eviction of families and the break-up of families by their Minute 1371/70 is now showing signs of being effective; demands for temporary accommodation from previous council tenants is falling away but more and more families are being financially supported under the department's powers under the Children Act and by the aforesaid Minute to a degree never previously experienced in the borough. There is also an indication that the nature of the problem of homelessness is changing. There is an increase in the demand for unmarried and unsupported mothers wishing still to keep their children with them to support them and to bring them up - as one-parent families, and some very young couples with babies and starting family life without any secure accommodation are in a vulnerable situation and frequently find themselves homeless with nowhere to go. But the flexibility of the council's policies and the close liaison between the Health and Housing Departments and the Social Services Department up to now at least has invariably found an answer. Number of temporary accommodation units as at 31st December, 1970:- 25,Cheam Road-consisting of 3 units (to be closed when 10, Rosswood Gardens, Wallington, is completed) 'Ladymount'-consisting of 4 units 6, Rosswood Gardens-consisting of 4 units 8, Rosswood Gardens-consisting of 4 units and Warden's accommodation. 73 Number of rehabilitation units:- 11 'motorway' houses 5 Housing properties 1 miscellaneous property As at 31.12.70 Number of families in temporary accommodation units 14 Number of children in temporary accommodation units 28 Number of families in rehabilitation units 17 Number of children in rehabilitation units 48 74 HOUSING DIVISION PART V C. SMITH, DPA (Lond.) FIHM. Housing Manager 75 Housing Division Reference was made in the previous annual report of the urgent need for additional elderly person's dwellings and that the Council had instructed the Borough Architect and Planning Officer to proceed as quickly as possible. During 1970 efforts have been made to organise sites for such development and schemes are now being prepared by the Borough Architect and Planning Officer for elderly persons in Cheam, Sutton and Carshalton. Discussions are also taking place with Housing Associations to further augment the provision of this type of accommodation throughout the borough. On the retirement of the Director of Health and Family Services on 31st December, 1970 and the introduction of a Social Services Department, the Council decided to reconstitute the Housing Division as a separate department as from 1st January, 1971, with the housing functions rent collection remaining with the Borough Treasurer and repairs and maintenance with the Borough Architect and Planning Officer. New Properties During 1970, 477 (573) properties were completed. These were at Durand Close, Carshalton and at Roundshaw, Wallington. Total Number of Properties The total number of properties owned by the Council and let by the Housing Division as at 31st December, 1970 was 5,628 (5,151). Building Programme Building operations proceeded in the year under review at Benhill Avenue, Sutton, and will provide 429 properties for letting in 1971 and 1972. A second contract for the building of a residential home and accommodation for the elderly people will follow on an adjoining site at Benhill Avenue. The Greater London Council are also developing the land at Shanklin Road, Belmont, formerly prefabricated bungalows, and providing 426 units. Negotiations are proceeding with the Greater London Council to acquire nomination rights for approximately 150 units. Housing Waiting List At 31st December, 1970 there were 2,239 (1,868) on the housing waiting list of which 585 were from elderly persons. Lettings, Mutual Exchanges and Transfers During 1970, 593 (725) were completed and 153 (43) mutual exchanges and transfers were arranged. Rehousing from Clearance and Re-development Areas During the year 1970 there were 11 families rehoused to provide the closing of accommodation in Clearance and Redevelopment Areas. Housing of Special Cases During 1970, 71 applicants were rehoused under powers vested in the Director of Health and Family Services on medical grounds and 42 applicants were rehoused being families in urgent need of accommodation. 76 77 ADMINISTRATION DIVISION PART VI "I think you are putting them in their wrong places. The heart is on the left and the liver on the right. Yes, that was so in the old days. But we have changed all that." J.B. Poquelin, called Moliere 1622-1673 D.S. CLAPSON, DPA (Lond.), LMRSH, MILGA Chief Administrative Officer 78 This report, covering the period 1st January, 1970 to 26th May, 1971 is the second and final report of the work of the Administration Division of the Health and Family Services Department which, with the implementation of the Local Authority Social Services Act, 1970, ceases to exist on 26th May, 1971. It was an uninspiring period during which the enthusiasms of 1968/60 were dissipated by the threat of further change. Four studies were carried out during the period under review with the assistance of the O & M Officer, on administrative and clerical procedures in the school health service; on secretarial and typing services; on clerical procedures associated with clinics and the work of health visitors and school nurses; and on administrative and clerical organisation and methods in the Social Services Division. At the request of the Director the five senior administrators undertook a study of administration within the context of changes arising from the Local Authority Social Services Act 1970: their unanimous report and recommendatior dated 21st October, 1970 evoked no response. A new post was created to deal with miscellaneous licensing functions, providing some relief to the hard-pressed section working at The Lodge in support of the Chief Public Health Inspector and his staff. The Council also approved the appointment of a third Senior Public Health Inspector as it became clear that some reorganisation of environmental health is needed to meet the increased work load effectively. Some additional administrative and clerical support would appear to be necessary and an O & M study of the admin/clerical needs of the Environmental Health Division will be undertaken in July 1971. The Government has stated that re-organisation of the National Health Service will become effective on 1 st April, 1974; it is to be hoped that this further dramatic upheaval of local authority health services together with the emphasis now given to social services will not result in the development of environmental health, which is expected to remain with local authorities, being over-looked during the period when so much time and effort will need to be devoted to the re-organisation of the National Health Service. Two one-day seminars were held during the early summer of 1970 at which clerical staff were introduced to the techniques of organisation and methods, administrative structures and communications; a potted version of this successful form of in-service training was presented to field workers in March 1971. Training for decimalisation started in the autumn of 1970 and the staff faced D Day with a reasonable degree of equaminity. In the event the form of training in which staff participated turned out to be rather too academic as well as lengthy and detailed. Such difficulties as occurred were trivial and irritating and arose during a short period immediately after 15th February, 1971, largely from the balancing of accounts where conversions gave rise to 'gains and losses'. Preparations for the transfer of weekly time sheets to computer application got under way early in 1971; the critical factor was the speed of turnover between the employee, the certifying department and the Borough Treasurer. The new time table was operated in the department for some weeks before the computer application started as a means of facilitating the transfer. The change-over produced few problems. Preliminary consultations on Job Evaluation started towards the end of the period under review. It is sad to record the break-up of the Health and Family Services Department after so short a life. The principles on which it was founded are sound and its unrealised potential in a forward looking Local Authority was great. To those members of my Division who have loyally supported the Council, the Director and myself in the execution of these principles during a period when it became clear that the potential would probably never be realised, I convey my sincere thanks. Loyalty, like Art, must on occasion be its own reward. Once again, the co-operation of our colleagues in other departments must be acknowledged. 79 Once more we are faced with building for the future on what was best of the past; in whatever capacity the staff of Administration Division serve the Authority after 26th May, 1971, the experience of the last three years will for many prove to be a corner stone of their future development in the public service. The Local Authority Social Services Act 1970 contains much that is open to criticism by those who regard a decision-making local government as essential to our way of life. Having become over-involved in management functions properly the responsibility of local authorities during the initial stages of the implementation of the Social Services Act, there are hopeful signs that Central Government is now more willing to allow Social Services departments to function and realise their potential within the democratic processes exemplified in a healthy local government. That reorganisation of the Health Services will mean the withdrawal of Personal Health Services from local authorities can only be regarded as a matter of regret by those of us who, by association with the fine traditions built up in the Local Authority Health Services, are proud to be local government officers. Understandable and perhaps not completely unjustified fears that reorganisation of the Health Services will comprise an element of 'take-over' by the present largest partner must be allayed: this is an occasion when justice must not only be done but manifestly be seen to be done. "I am the daughter of Earth and Water, And the nursling of the Sky: I pass through the pores of the ocean and shores; I change but I cannot die". P.B.Shelley 1792-1822 80 APPENDICES Page No. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING 1970 2 INFECTIOUS DISEASES NOTIFIED DURING THE PERIOD 1st JANUARY - 6 31st DECEMBER 1970 1st JANUARY- 7 31st DECEMBER 1969 PREMATURITY 8 NUMBER OF CASES ON OBSERVATION AND HANDICAP REGISTER 9 THE HANDICAPPED PRE SCHOOL CHILD 10 CHILD WELFARE CENTRES - NUMBER OF CHILDREN ATTENDING 12 DENTAL CARE OF MOTHERS AND YOUNG CHILDREN - ATTENDANCES AND 13 TREATMENT MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY AND 14 SECONDARY SCHOOLS DEFECTS FOUND BY PERIODIC AND SPECIAL MEDICAL INSPECTIONS 15 SCHOOL DENTAL SERVICE -ATTENDANCES AND TREATMENT 17 CHILD GUIDANCE CLINIC 19 SCHOOL PSYCHOLOGICAL SERVICE 20 HANDICAPPED PUPILS 21 1 2 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING 1970 Causes of Death Sex Total all ages Under 4 weeks 4 weeks and under 1 year 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and over Enteritis and other Diarrhoeal Diseases M _ _ _ _ _ _ _ _ _ _ _ _ F 1 - - - - - - - - - - 1 Tuberculosis of Respir atory System M 4 _ _ _ _ _ _ _ _ _ _2 2 F 4 - - - - - - - - - 1 3 Late Effects of Respiratory T.B. M 1 _ _ _ _ _ _ _ 1 - _ _ F 2 - - - - - - 1 - 1 - - Other Tuberculosis M 1 _ _ _ _ _ _ _ 1 _ _ _ F 1 - - - - - - 1 - - - - Syphilis and its Sequelae M 2 _ _ _ _ _ _ _ _ _ _ 2 F 2 - - - - - - - - - 2 Other Infective and Parasitic Diseases M 1 _ _ _ _ _ _ _ _ _ _ 1 F 3 _ _ _ _ _ _ _ _ 1 _ 2 Malignant Neoplasm, Buccal Cavity Etc. M _ _ _ _ _ _ _ _ _ _ 1 _ F _ _ _ _ _ _ _ _ _ _ _ _ Malignant Neoplasm Oesophagus M 6 _ _ _ _ _ _ _ _ 2 3 1 F 2 - - - - - - - 1 _ 1 _ Malignant Neoplasm, Stomach M 21 _ _ _ _ _ _ _ 2 8 5 6 F 20 - - - - - - - 1 3 4 12 Malignant Neoplasm, Intestine M 19 _ _ _ _ _ _ _ 2 4 6 7 F 40 - - - - - - - 2 8 8 22 Malignant Neoplasm, Lung, Bronchus M 109 1 1 10 31 45 21 F 23 - - - - - _ 1 3 3 8 8 Malignant Neoplasm, Breast M _ _ _ _ _ _ _ _ _ _ _ _ F 47 _ - - - _ 1 2 3 15 14 12 Malignant Neoplasm, Uterus F 17 - - - - - - - 3 4 5 5 3 Causes of Death Sex Total all ages Under 4 weeks 4 weeks and under 1 year 1 -4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and over Malignant Neoplasm, Prostate M 18 _ _ _ _ _ _ _ _ 2 5 11 Leukaemia M 8 _ _ _ 1 _ _ 1 . 2 3 1 F 5 - - - _ - - - 1 3 - 1 Other Malignant Neoplasms M 47 _ _ 1 _ 1 1 1 6 17 13 7 F 59 - - - - - - 2 9 17 17 14 Benign & Unspecified Neoplasms M - _ _ _ - _ _ _ _ _ 1 1 F - - - - - - - - - - - - Diabetes Mellitus M 3 _ _ _ _ _ _ _ 2 _ _ 1 F 10 - - - - - - - 1 4 5 Other Endocrine etc. Diseases M 2 _ _ _ 1 1 _ _ _ _ _ _ F 2 - - - - - _ - - 1 1 _ Anaemias M 1 _ - _ _ _ - _ _ - 1 - F 4 _ _ _ _ _ _ _ _ _ _ 4 Mental Disorders M 2 _ _ _ _ _ 2 _ _ _ _ _ F 6 - - - - - _ - - 1 1 4 Meningitis M 1 _ _ _ _ _ _ _ 1 _ _ _ F 1 - - - - - 1 - - - - - Multiple Sclerosis M 2 _ _ _ _ _ 1 _ _ _ 1 _ F 1 - - - - - - - - 1 - - Other Diseases of Nervous System M 3 _ _ _ _ _ _ _ _ _ 2 1 F 8 _ 1 _ 1 1 _ _ _ _ 2 3 Chronic Rheumatic Heart Disease M 7 _ _ _ _ _ _ _ 1 _ 3 3 F 13 - - - - - - 1 1 3 4 4 Hypertensive Disease M 16 _ _ _ _ _ _ _ 2 1 6 7 F 21 - - - - - - - 2 2 3 14 Ischaemic Heart Disease M 256 _ _ _ _ _ _ 2 21 68 85 80 F 187 - - - - - - - 4 20 34 129 4 Causes of Death Sex Total all ages Under 4 weeks 4 weeks and unde 1 year 14 5-14 15-24 25-34 3544 45-54 55-64 65-74 75 and over Other forms of Heart Disease M 35 _ _ _ _ _ _ _ 1 2 11 21 F 97 - - - - - 1 - 1 1 14 80 Cerebrovascular Disease M 103 _ _ _ _ _ _ 1 7 15 37 43 F 176 - - - - - - 5 17 30 124 Other diseases of Circulatory System M 35 _ _ _ _ - 1 _ 1 2 15 16 F 49 - _ - - - 1 1 4 3 8 32 Influenza M 8 _ - _ _ - - 1 _ 3 2 2 F 11 - - - - 1 _ 1 _ 1 4 4 Pneumonia M 50 2 _ _ _ _ 1 _ 1 4 14 28 F 74 1 - - - 1 - - 2 3 10 57 Bronchitis and Emphysema M 79 _ 1 _ _ _ _ 1 _ 14 39 24 F 19 - - 1 - - 1 - 1 1 4 11 Asthma M 2 _ - _ _ - _ _ _ 1 1 _ F 1 - - - - 1 - - - - - - Other Diseases of Respiratory System M 8 _ _ 1 _ _ _ 1 1 2 3 _ F 8 - - - - - - _ _ _ _ 8 Peptic Ulcer M 6 _ _ _ _ _ _ _ _ _ 5 1 F 5 - - - - - - - - - 2 3 Appendicitis M _ _ _ _ _ _ _ _ _ _ _ _ F 3 - - - - - - - - 1 - 2 Intestinal Obstruction M 1 _ _ _ _ _ _ _ _ 1 _ _ F 6 - - - - - - - - 2 - 4 Cirrhosis of Liver M 1 _ - _ _ _ _ _ - 1 _ - F - - - - - - - - - - - - Other Diseases of Digestive System M 9 _ _ _ _ _ _ _ 2 2 2 3 F 10 - - - - - - - - 1 2 7 Nephritis and Nephrosis M 5 _ _ _ _ _ _ _ _ 2 2 1 F 4 - - - - - - - - - 1 3 5 Causes of Death Sex Total all ages Under 4 weeks 4 weeks and under 1 year 14 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and over Hyperplasia of Prostate M 5 - - - - - - - - - 3 2 Other Diseases, Genito-Urinary System M 5 _ _ _ _ _ _ _ _ 1 2 2 F 17 _ - _ _ _ - - 1 2 2 12 Diseases of Skin, Subcutaneous Tissue M _ _ _ _ _ _ _ _ _ _ _ _ F 1 - - _ _ - - - - - - 1 Diseases of Musculoskeletal System M 8 _ _ _ _ _ _ 1 _ 1 5 1 F 11 - - - _ - - 1 1 1 4 4 Congenital Anomalies M 7 1 3 1 - - - 1 - - 1 _ F 9 4 - 1 1 - 1 - _ _ 2 _ Birth Injury, Difficult Labour, etc. M 3 3 _ _ _ _ _ _ _ _ _ _ F 6 6 - - - - - - _ _ - - Other Causes of Perinatal Mortality M _ _ _ _ _ _ _ _ _ _ _ _ F 4 4 - _ - _ _ - _ _ _ _ Syptom sand III Defined Conditions M 6 - _ - - - _ __ - - - 6 F 6 - - 1 - - - - - 5 Motor Vehicle Accidents M 20 - _ _ 3 5 3 1 2 5 - 1 F 6 _ - _ - 1 1 1 1 1 1 - All other Accidents M 8 _ _ _ 1 1 1 1 3 _ _ 1 F 12 - 1 - - - - - - 1 2 8 Suicide and Self-inflicted Injuries M 11 _ _ _ _ 1 1 2 1 4 - 2 F 6 _ _ - _ - - - 1 3 2 - All other External Causes M 2 - _ - - _ _ 1 1 - - - F 2 _ - 1 - - - - - 1 _ - TOTAL ALL CAUSES M 950 6 4 3 6 9 12 16 69 195 324 306 F 1022 15 2 3 2 6 7 12 47 123 195 610 1969 TOTAL ALL CAUSES M 971 8 5 5 7 10 8 20 59 201 308 340 F 1054 17 10 5 3 2 3 13 54 116 226 605 6 INFECTIOUS DISEASES NOTIFIED DURING THE PERIOD 1st JANUARY TO 31st DECEMBER, 1970 Disease Under 5 5-14 15-44 45 - 64 65 or over Aae unknown TOTAL M F M F M F M F M F M F M F Diphtheria - - - - - - - - - - - - - - Dysentery 17 20 3 3 2 9 - - - - - - 22 32 Encephalitis - - - - - 1 - - - - - - - 1 Food Poisoning - - 1 1 - 1 2 1 - - - - 3 3 Infective Jaundice - - 13 11 5 9 2 3 - - - - 20 23 Malaria - - - - - - - - - - - - - - Measles 122 88 86 81 3 2 - - - - 2 3 213 174 Meningococcal Meningitis _ _ _ _ _ 1 _ _ _ _ _ _ _ 1 Ophthalmia Neonatorum - - - - - - - - - - 1 - 1 - Paratyphoid - - - - - 1 - - - - - - - 1 Poliomyelitis - - - - - - - - - - - - - - Scarlet Fever 10 10 24 26 1 1 - - - - - 2 35 39 Smallpox - - - - - - - - - - - - - - Typhoid - - - - - - - - - - - - - - Tuberculosis (Pulmonary) - - - - 6 7 4 3 5 3 - _ 15 13 Tuberculosis (Non-Pulmonary) - - - _ 1 _ _ _ _ 3 _ _ 1 3 Whooping Cough 15 13 9 8 - 2 - 1 - - - - 24 24 7 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 - 1 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 - - - - - 1 1 - - - - - 1 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 8 PREMATURITY The following table gives details of premature births and stillbirths notified in the London Borough of Sutton during the period 1st January -31st December 1970 as adjusted by transferred notifications; (1969 figures in brackets). Weight at Birth Premature Live Births Premature Stillbirths Born in Hospital Born at home or in a Nursing 1 Home ransferred to Hospital on or before the 28th day Born at home or in a Nursing Home Born in Hospital DIED DIED T 0 T A L Within 24 hrs. of birth Between 1 and 7 days Between 7 and 28 days T 0 T A L Within 24 hrs. of birth Between 1 and 7 days Between 7 and 28 days T 0 T A L Within 24 hrs. of birth Between 1 and 7 days Between 7 and 28 days 2lb. 3 ozs. or less 4 3 _ 1 _ _ _ _ _ _ _ _ 1 1 (3) (2) (1) (-) (-) (-) (-) (-) (-) (-) (-) (-) (-) (2) over 2lb. 3 ozs. up to and inc 3lb. 4 ozs. 10 2 1 _ _ _ _ _ _ _ _ _ _ 1 (6) (2) (-) (-) (-) (-) (-) (-) (-) (-) (-) (-) (-) (4) over 3lb. 4 ozs. up to and inc 4 lb. 6 ozs. 28 2 1 1 _ _ _ _ _ _ _ _ _ 3 18) (2) (1) (1) (1) (-) (-) (-) (1) (-) (-) (1) (-) (1) over 4lb. 6 ozs. up to and inc 4lb. 15 ozs. 24 _ _ _ 1 _ _ _ _ _ _ _ _ 1 20) (-) (2) (-) (-) (-) (-) (-) (-) (-) (-) (-) (-) (-) OVER 4lb. 15 ozs. up to and inc 5lb. 8 ozs. 68 _ _ _ 2 1 _ _ _ _ _ _ _ 3 (48) (-) (2) (-) (1) (-) (-) (-) (-) (-) (-) (-) (-) (-) TOTAL 34 7 2 2 3 1 _ _ _ _ _ _ 1 9 (95) (6) (6) (1) (2) (-) (-) (-) (1) (-) (-) (1) (-) (8) THE OBSERVATION AND HANDICAP REGISTER Table 1 Number of cases on Register As at Year of Birth TOTAL 1966 1967 1968 1969 1970 31.12.70 106 128 138 121 199 692 31.12.69 154 169 173 153 _ 649 Table 2 Number of cases with severe or multiple handicaps As at Year of Birth TOTAL 1966 1967 1968 1969 1970 Number of 31.12.70 severely Handicapped 31.12.69 preschool children 6 2 2 1 _ 11 6 2 2 _ _ 10 Number of 31.12.70 pre-school children with 31.12.69 multiple defects 11 8 2 2 3 26 12 10 2 1 25 9 TABLE 3 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 of Defect Year of Birth 1966 1967 1968 1969 1970 TOTAL DEFECTS OF EAR OR FACE including: absence of pinna or meatus, accessory auricle, bat ear, naevae, skin tags, micrognathia 1 3 2 1 1 8 DEFECTS OF MOUTH including: hare lip, cleft palate 2 3 2 4 11 DEFECTS OF ALIMENTARY SYSTEM including: pyloric stenosis, oesophagael atresia, jejunal atresia, imperforate anus, defects of liver, hernia, Hirschsprung's disease 3 8 10 10 8 39 Osteogenesis Imperfecta 1 1 2 SKELETAL DEFORMITIES including: achondroplasia, chondrodystrophy, dwarfism, arachnodactyly, reduction deformities, Pierre Robine Syndrome 3 3 2 2 10 SYNDACTYLY, POLYDACTYLY 1 2 1 1 1 6 TALIPES, AND OTHER FOOT DEFORMITIES 3 6 6 6 11 32 CONGENITAL DISLOCATION OF HIP 2 3 3 5 2 15 DEFECTS OF UROGENITAL SYSTEM including: Hypospadias, epispadias, undescended testicles, hydrocele, defects of female genitalia, defects of kidney, ureters, etc. pseudo- hermaphrodism 3 9 3 1 1 17 MUSCULAR DEFECTS including: spastic, absence of muscles, arthogryphosis, torticollis, hemiplegia 3 3 2 1 4 13 OTHER MINOR PHYSICAL DEFORMITIES including: polonidal sinus _ 2 3 3 2 10 10 Year of Birth Handicap or Defect 1966 1967 1968 1969 1970 TOTAL BLINDNESS 1 1 2 MICROPHTHALMOS, BUPHTHALMOS 1 1 2 SQUINT 6 7 2 1 16 NYSTAGMUS SEVERE VISION DEFECT, CATERACT 2 2 4 DEAFNESS 1 1 PARTIAL HEARING or HEARING DEFECTS 5 3 5 2 15 SPEECH DEFECTS 7 3 1 11 DISEASES AND DEFECTS OF RESPIRATORY SYSTEM INCLUDING: Hyaline membrane disease, asthma, chronic bronchitis 5 5 8 3 7 28 BLOOD DISORDERS, including: Christmas Disease 2 4 5 4 2 17 SKIN DISORDERS, including: Ichthyosis congenita, eczema, 2 8 5 3 1 19 METABOLIC DISORDERS INCLUDING: Fibrocystic disease 4 2 2 8 PHENYLKETONURIA CARDIAC DEFECTS 7 15 11 4 5 42 OTHERS NEEDING OBSERVATION for suspected physical defect 38 32 48 66 142 326 MENTAL RETARDATION 3 1 2 6 MICROCEPHALY 1 1 2 EPILEPSY, OR SEVERE CONVULSIONS 3 2 1 1 2 9 MONGOLISM 2 3 4 2 1 12 SPINA BIFIDA, HYDROCEPHALUS 2 8 5 5 4 24 OTHERS NEEDING OBSERVATION FOR MENTAL RETARDATION AND OTHER C.N.S. LESIONS 5 1 5 2 1 14 11 12 CHILD WELFARE CENTRES YEAR Number of children who attended during period 1st January 1970 to 31st December 1970 1st Attendances of Children Born in: No. of Sessions held by No. of Children referred elsewhere for consultant advice 1970 1969 1965/68 TOTAL Total Attendances Asst. Medical Officers G.P.s employed on sessional basis Total No. of Sessions 1970 2490 2857 5000 10347 51459 1003 75 1078 30 1969 2589 2494 2572 10355 40055 1192 126 1318 40 DENTAL CARE OF MOTHERS AND YOUNG CHILDREN Attendances and Treatment Expectant & Nursing Mothers Children under 5 1970 1969 1970 1969 Inspection 33 36 867 1118 No. found to require treatment 31 32 355 401 No. offered treatment 30 30 352 377 Re-inspection 5 4 139 125 No. found to require treatment 5 3 65 68 First visits for treatment 38 36 348 394 Subsequent visits 73 93 707 716 Total visits 111 129 1055 1110 Additional courses of treatment 3 5 47 38 Fillings 97 107 1152 1183 No. of teeth filled 73 88 1061 1091 Extractions 31 19 152 185 General anaesthetics 6 11 84 96 Emergency visits 3 3 46 63 Patients x-rayed 13 15 5 7 Sea lings 23 10 35 20 Teeth otherwise conserved - - 41 71 Teeth root filled 3 - - 1 Crowns - - - - Inlays - - - - No. of Dentures supplied 2 11 1 Courses of treatment completed 24 19 353 362 Sessions devoted to inspection and treatment 12 14.55 162.5 176.8' Sessions devoted to Health Education 3 - 7 - 13 14 MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY SCHOOLS (INCLUDING NURSERY AND SPECIAL SCHOOLS) TABLE (a) PERIODIC MEDICAL INSPECTIONS 1st JANUARY - 31st DECEMBER, 1970. Age Groups Inspect (By year of birth) No. of Pupils who have received a full medical examination Physical Condition No. of Pupils found not selected for examination Pupils found to require treatment (excluding dental diseases and infestation with vermin Satis. Unsatis.. For defective vision (excl. squint) For any other condition Total Individual Pupils (1) (2) (3) (4) (5) (6) (7) (8) 1966 and later 333 333 - - - 18 26 1965 2100 2099 1 - 59 109 160 1964 535 535 - - 12 26 34 1963 184 184 - - 3 15 17 1962 1505 1505 - - 65 74 121 1961 497 497 - - 18 29 44 1960 96 96 - - 3 6 8 1959 66 66 - - 4 8 11 1958 954 954 - 214 64 53 111 1957 556 556 - 103 37 17 50 1956 953 953 - - 55 35 88 1955 & earlier 1566 1566 - - 162 38 193 TOTAL 9345 9344 1 317 490 428 863 15 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 Entrants PERIODIC INSPECTIONS Special Inspections Leavers Others Total 1970 1969 1970 1969 1970 1969 1970 1969 1970 1969 4 Skin T 12 24 17 35 53 63 82 122 283 293 0 60 82 58 27 116 55 234 164 1 - 5 Eyes (a) Vision T 67 95 217 196 206 312 490 603 51 65 0 97 167 201 46 251 275 549 488 12 8 (b) Squint T 67 53 10 5 54 25 131 83 1 1 0 23 43 3 2 25 16 51 61 - - (c) Other T 3 6 4 1 7 8 14 15 2 4 0 3 9 6 - 12 4 21 13 - - 6 Ears (a) Hearing T 15 17 3 5 16 18 34 40 83 87 0 48 90 20 6 70 50 138 146 5 - (b) Otitis Media T 4 7 2 - 7 1 13 8 _ - 0 38 89 11 2 44 17 93 108 - - (c) Other T - 2 1 1 1 4 2 7 2 4 0 1 11 2 2 8 6 11 19 - - 7 Nose and Throat T 36 72 9 3 51 51 96 126 8 9 0 302 633 77 22 412 233 791 888 1 2 8 Speech T 35 70 2 3 27 27 64 100 22 27 0 98 166 6 2 27 19 131 187 3 _ 16 Defect Code No. Defect or Disease PERIODIC INSPECTIONS Entrants Leavers Others Total Special Inspections 1970 1969 1970 1969 1970 1969 1970 1969 1970 1969 9 Lymphatic T 3 2 - - 3 1 6 3 _ _ Glands 0 38 137 3 3 49 49 90 189 2 - 10 Heart T 2 3 1 1 9 4 12 8 1 1 0 30 71 11 4 32 25 73 100 1 - 11 Lungs T 9 16 1 2 12 18 22 36 20 9 0 74 118 41 22 116 77 231 217 2 - 12 Developmenta (a) Hernia T 31 1 - 1 8 - 39 2 - 1 0 5 13 2 - 1 1 8 14 - - (b) Other T 22 13 3 5 12 33 37 51 10 9 0 23 56 12 11 41 49 76 116 - - 13 Orthopaedic (a) Posture T 5 2 8 6 6 6 19 14 9 9 0 2 9 30 7 20 14 52 30 - 1 (b) Feet T 19 26 13 6 15 31 47 63 23 28 0 52 61 25 21 62 42 139 124 1 - (c) Other T 6 22 7 9 6 12 19 43 16 21 0 25 35 39 18 37 21 101 74 1 - 14 Nervous System (a) Epilepsy T 2 3 2 - 4 4 8 7 2 1 0 7 7 3 3 11 9 21 19 - - (b) Other T _ 3 _ 1 1 4 1 8 _ 2 0 9 5 5 4 9 12 23 21 - - 15 Psychological (a) Development T 1 3 - 27 5 31 6 61 23 21 0 27 57 11 2 73 29 111 88 1 - (b) Stability T 2 11 1 4 7 17 10 32 8 11 0 45 78 31 7 62 37 138 122 2 - 16 Abdomen T 3 1 1 5 2 - 6 6 10 5 0 16 30 12 8 30 26 58 64 1 - 17 Other T _ 3 3 _ _ 18 3 21 169 223 0 15 20 11 9 2 41 28 70 24 - SCHOOL DENTAL SERVICE 1. Attendances and Treatment 5 - 9 years 10-14 years 15 years and over TOTAL 1970 1969 1970 1969 1970 1969 1970 1969 First Visit 1901 1812 1394 1522 295 334 3590 3668 Subsequent Visits 3366 3167 2827 3102 748 718 6941 6987 Total Visits 5267 4979 4221 4624 1043 1052 10531 10655 Additional courses of treatment commenced 447 407 227 216 42 43 716 666 Fillings in permanent teeth 1711 1855 3246 3782 1072 1173 6029 6810 Fillings in deciduous teeth 4366 4166 319 330 - - 4685 4496 Permanent teeth filled 1454 1541 2621 3219 834 968 4909 5728 Deciduous teeth filled 3982 3720 296 286 - - 4278 4006 Permanent teeth extracted 75 29 391 315 89 79 555 423 Deciduous teeth extracted 1254 1001 360 400 - - 1614 1401 General Anaesthetics 620 479 265 256 30 26 915 761 Emergencies 297 212 85 73 12 33 394 318 Number of pupils x-rayed 488 (298) Prophylaxis 320 (286) Teeth otherwise conserved 166 (179) Number of teeth root filled 12 (10) Inlays 1 (1) Crowns 10 (9) Courses of treatment completed 3869 (3658) 2. Orthodontics 1970 1969 New cases commenced during 1970 72 57 Cases completed during year 79 72 Cases discontinued during year 2 72 No. of removable appliances fitted 114 95 Pupils referred to Hospital Consultant 18 12 3. Prosthetics Ages 5 - 9 Ages 10-14 Ages 15 and over TOTAL 1970 1969 1970 1969 1970 1969 1970 1969 Pupils supplied with F.U. or F.L. (first time) _ _ _ _ _ _ _ _ Pupils supplied with other dentures (first time) _ _ 1 3 _ 1 1 4 Number of dentures supplied 1 - 2 4 2 2 5 6 4. Anaesthetics General anaesthetics administered by dental officers Nil (Nil) 5. Inspections 1970 1969 (a) First inspection at school. No. of pupils 17,847 16,075 (b) First inspection at clinic. No. of pupils 2,073 2,326 No. of (a) + (b) found to require treatment 9,620 9,293 No. of (a) + (b) offered treatment 8,173 7,484 (c) Pupils re-inspected at school clinic 2,406 1,983 No. of (c) found to require treatment 1,465 1,324 6. Sessions Sessions devoted to treatment 1552.85 1602.5 Sessions devoted to inspection 179.15 164 Sessions devoted to Dental Health Education 5 2 18 CHILD GUIDANCE CLINIC - STATISTICS 1970 Psychiatric sessions Diagnostic interview with children 84 (108) Treatment interviews 259 (267) Court reports 6 (5) Boarding school reviews 13 (9) Case discussion (supervision) 133 (39) Discussion of North Downs cases 22 (17) Meeting outside agencies 16 (39) Outside visits 6 (-) Appointments arranged but failed 20 (31) Psychiatric Social Worker Sessions Treatment interviews 1336 (878) Case discussions 297 (76) Meeting outside agencies 15 (26) Home visits 43 (32) Supervision of students 43 (38) Outside visits 14 (7) Appointments arranged but failed 155 (127) Psychotherapist sessions Treatment interviews 1353 (1256) Case discussions 187 (90) Outside visits 2 (3) Meeting outside agencies 6 (5) Appointments arranged but failed 126 (127) The number of children referred to the Clinic during 1970 was 130 The agencies initiating referral were General Practitioners 58 (61) School Health Services 23 School Psychological Service 22 Courts 6 Social Services 4 Hospitals or Specialists 9 Schools 130 Although this has not been included in the figures, the Psychiatrist sessions include a good deal of teaching of students, such as Registrars from Hospitals, a student from the Institute of Education, social work students, etc. 19 SCHOOL PSYCHOLOGICAL SERVICE In 1970 a total of 544 children presented a variety of learning and behaviour problems and were assessed by the psychologists, the main source of referral being head teachers and the Principal School Medical Officer. Other sources of referral and the recommendations made are as follows :- Source of Referrals other than by the Child Guidance Clinic during 1970 Principal School Medical Officer 173 (138) Head Teachers directly 205 (152) Carew Manor E.S.N. School 56 (64) Other 44 (31) Education 10 (-) TOTAL 488 (385) Main Recommendations made: To Carew Manor E.S.N. School 37 (21) To Training Centre 6 (3) To Infant Observation/Diagnostic Classes 22 (18) To Borough Remedial Units 27 (35) To Other Schools 42 (28) To Child Guidance Clinic referral 22 (26) Hospital Investigation 24 (21) Youth Employment Officer 7 (1) Speech Therapist 3 (3) Children's Department 8 (1) Specific review and re-assessment 170 (121) Report and advice only 98 (108) TOTAL 466 (386) 20 21 HANDICAPPED PUPILS Number of pupils registered as handicapped Handicapped pupils requiring education at Special Schools approved under Section 9(6) of the Education Act 1944 or Boardinq in Boarding Homes during the years 1st January - 31st December 1970 and 1969. Blind Partially Sighted Deaf Partially handicapped Physically handicapped Delicate Maladjusted E.S.N. Epileptic Speech Defects Total Children newly assessed as needing special educational treatment at special schools 70 69 70 69 70 69 70 69 70 69 70 69 70 69 70 69 70 69 70 69 70 69 _ _ 3 5 _ _ 2 4 10 9 4 7 7 16 29 25 _ _ 1 _ 56 66 Number of children receiving special educational treatment in (a) Boarding Special Schools or Homes 1 _ _ 2 3 _ 1 2 8 6 5 10 7 7 10 14 1 1 _ _ 36 43 (b) Day Special Schools - - 9 10 9 8 - - 17 12 7 6 5 129 120 171 161 (c) Independent Boarding Schools - - - - - - - - 2 2 _ 21 26 1 1 _ _ _ _ 24 29