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There are 164 outworkers so notified engaged in the following trades:β€” Wearing apparel 95 Household linen 1 Curtains and furniture hangings 1 Brass and brass articles 8 Artificial flowers 7 Making of boxes etc. 32 Stuffed toys 2 Cosaques, Christmas stockings, etc. 1 Lampshades 17 The Public Health Inspectors made 146 visits to such premises. No unsatisfactory conditions were noted. 65 RAG, FLOCK AND OTHER FILLING MATERIALS The Rag, Flock and Other Filling Materials Act, 1951 requires the registration of premises where filling materials are used in the manufacture of bedding, toys, baby carriages and other articles of upholstery and the licensing of premises where Rag Flock is manufactured or stored for distribution. Regulations made under the Act apply standards of cleanliness for filling materials and prescribe the form of records to be kept by occupiers of registered or licensed premises. Five premises registered under the Act were inspected and found to be satisfactory.
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SWIMMING POOLS There are 4 public swimming establishments as follows:β€” Squires Lane, Finchley (indoor). High Road, North Finchley. Daws Lane, Mill Hill, N.W.7. Goldsmith Avenue, West Hendon. All establishments are equipped with modern filtration and chlorination plants. During 1967 there were more than 366,000 visitors to these pools including nearly 70,000 school children. Whilst the indoor swimming pool is generally available throughout the whole of the year, the season for the three open air pools is usually from the end of April to the middle of September. Nine schools have teaching pools provided either by the Education Authority or by parent-teacher associations. There is also one privately owned pool which is open to the public. Samples taken by the Public Health Inspectors from all pools, additional to the daily checks made by the operating staffs, show that a generally high bacteriological standard was maintained.
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Public slipper baths are available at 3 sites in the Borough:- Cloister Road, Childs Hill Borthwick Road, West Hendon Squires Lane, Finchley. At prescribed times, Old Age Pensioners may have the free use of washing facilities at certain establishments. SANITARY CONVENIENCES There are 29 male and 27 female public conveniences adjoining the highways and 37 male and 37 female conveniences within the curtilage of the Council's parks and open spaces. 78 of these 66 conveniences have free hand washing facilities including 8 installations of an improved type of hand washing and drying machine. The majority of these conveniences are subject, in varying degrees, to vandalism and misuse which has an adverse effect on the benefits otherwise available to members of the public. SEWERAGE AND SEWAGE DISPOSAL Except for a few isolated areas, the Borough is provided with a separate system of foul and surface water sewers.
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The system which collects rain water only discharges into local natural water courses and the other system is linked with one of three treatment plants. A small area of the northern part of the district drains to the West Hertfordshire main drainage works at Maple Cross near Rickmansworth, whilst the remainder goes to the disposal works of the Greater London Council at either Edmonton or Mogden. The trunk sewers which convey the sewage to the disposal works of the Greater London Council are vested with that authority, but all the other sewers are the responsibility of the Borough Council. There are a few areas of old development where both rain water and foul sewage are conveyed by a single sewer into the foul system, but as these areas are redeveloped opportunity is taken to link them to the separate systems. In the more rural parts of the northern area there are also some properties which drain to cesspools, for which an emptying service is operated by the Council whereby 8 clearances per annum are carried out free of charge.
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Schemes are in the course of preparation to connect certain of these properties to main drainage. There are certain areas where flooding occurs during periods of abnormal storms and a comprehensive examination of the sewerage systems within the whole of each drainage area is to be carried out to ascertain the extent of the capital expenditure required to deal with the problem. REFUSE COLLECTION AND DISPOSAL The collection of refuse remains the responsibility of the local authority under the control of the Borough Engineer and Surveyor, but the disposal is the responsibility of the Greater London Council. Most of the vehicles used in this service are of the modern compression type operating on 44 collection rounds to give a weekly service. The refuse is taken to either Summers Lane, Finchley, where the Greater London Council arrange for its transportation to tipping areas outside London or to the refuse destructor on the North Circular Road, Hendon, N.W.2. operated by the same authority.
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Complaint was received from a number of people who live in the vicinity of the transfer station about dust created by the decanting of refuse from collection vehicles to the bulk transporters. This was referred to the Greater London Council. Special arrangements are made for the regular clearance of trade refuse as required, whilst a 67 service is available on prepayment for the collection and disposal of unwanted cars, furniture, garden refuse, rubble, etc. In addition members of the public may take any items which they wish to dispose of to either of the above mentioned depots of the Greater London Council during the hours of 8.0 a.m. to 4.0 p.m. on weekdays and 8.0 a.m. to 12 noon on Saturdays. In conjunction with the regular refuse collection service, arrangements are made for the collection and disposal of salvageable materials such as mixed paper, fibre boards, mixed rags.
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All ratepayers are therefore urged to keep items such as these separate from the normal refuse. ANIMALS The Animal Boarding Establishments Act 1963, with the Pet Animals Act 1951 and the Riding Establishments Act 1964 provide protective legislation to secure the well-being of cats and dogs, animals sold for pets, and horses hired out for riding. At the end of the year the following licences were in force, namely:β€” Animal Boarding Establishments Act 1963 3 Pet Animals Act 1951 20 Riding Establishments Act 1964 10 There is one establishment in the Borough, licensed by the Ministry of Agriculture, Fisheries and Food, for the detention of cats and dogs under quarantine following importation to this country. During the year 113 dogs were received at the premises after being authorised to land. The premises are kept under observation by the police and the Public Health Inspectors, to check on the presence and isolation of the animals for the required periods.
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Under the Movement of Animals (Records) Orders detailed records have to be kept by stockholders of the movement of cattle, sheep, goats and pigs to and from their premises. Animals noved on licence to premises within the Borough must be retained for 14 days before being removed elsewhere, unless a further licence is issued. During the year 568 pigs were moved into the district on 34 licences issued by the appropriate authorities covering the markets where the animals were purchased. Farm premises were visited to inspect the record books to ensure that the appropriate entries were made and that the animals were retained.The records show that the average numbers of stock held were:β€” Cattle 866 Pigs 2,749 Sheep 38 Poultry 28,340 The Diseases of Animals (Waste Food) Order 1957 requires that all waste foods to be used for the feeding of animals must be boiled to minimise the risk of spread of animal diseases. The boiling plants may only be operated if satisfactory and licensed.
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Sixteen licences were in force at the end of the year. Owing to an outbreak of Foot and Mouth Disease which assumed major proportions in Wales and 68 the Midlands during the latter part of the year, the Ministry of Agriculture, Fisheries and Food made the whole country subject to a Controlled Area Order, which required that no animals be moved without a licence. These licences are issued on behalf of the Authority by the Principal Health Inspector acting in his capacity as Inspector under the Diseases of Animals act. Some 31 licences were so issued permitting the movement within or into the Borough of 46 cows, heifers and calves, and 95 sows and 1641 pigs. Mr. J. Pickup, M.R.C.V.S., the Council's Consultant Veterinary Surgeon, retired on the 31st March 1967. Mr. J.H.
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Stockman, M.R.C.V.S., was engaged from the 1st April 1967 on a consultancy basis to assist in the inspection of animals and premises where necessary. RODENT CONTROL The Prevention of Damage by Pests Act 1949 places the onus on the occupier to rid his land and premises of rats and mice, but in practice it is found that the provisions of the Act are best administered by the Council providing a control service. This is carried out by a trained staff of rodent operatives and in accordance with recommendations of the Ministry of Agriculture, Fisheries and Food. In the case of dwelling houses, treatment is undertaken by the Council free of charge, and on a "time and cost" basis in respect of business premises. Treatment of sewers to reduce the level of infestation is carried out four times a year. Fluoracetamide, a dangerous poison, is used and the work is carried out by a specialist firm under contract.
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The arrangements for this work and its supervision are made with the co-operation of the Borough Engineer and Surveyor. The following table summarises the work carried out and is in the form required by the Ministry of Agriculture, Fisheries and Food. Properties other than Sewers Type of Property Non-Agricultural Agricultural 1. Number of properties in the district 116,628 41 2. (a) Total number of properties (including nearby premises) inspected following notification 2,811 4 (b) Number infested by (i) Rats 2,041 3 (ii) Mice 507 β€” 3. (a) Total number of properties inspected for rats and/or mice for reasons other than notification 64 6 (b) Number infested by (i) Rats 40 1 (ii) Mice β€” β€” The Rodent Operatives made 13,371 visits during the year.
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69 DISINFECTION AND DISINFESTATION Facilities for steam disinfection and disinfestation, and for the personal cleansing of verminous persons are provided for at the Disinfecting Station, North Circular Road, N.3. During the year 582 articles were treated, some of which were articles of clothing for dispatch abroad to countries which require a certificate that this has been done. Verminous conditions of premises and persons are fewer nowadays than ever before, but occasional ones are still to be found. The treatment of females and young children is done under supervision of a woman attendant specially employed. Requests for advice and assistance in dealing with insect pests increase in number and range over a wide variety. No less than 738 were in connection with wasps. Many of these insects are of no public health significance, but steps are taken to assist all enquiries.
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One must again express thanks to the Director of the Department of Entomology of the Natural History Museum for the helpful co-operation of his experts in the identification of numerous insects. Because of complaints from some residents of the depredations of the common squirrel, the Council decided to obtain traps and for a fee to hire them out upon request. "Wild" or "feral" pigeons are now a widespread pest, and in one area steps were, upon the request of residents, taken to reduce their numbers. Squirrels and pigeons are held in sentimental regard by many of the public, but often by wellmeant but misplaced kindness the invasion of residential districts by these creatures is encouraged. A charge is made for disinfection and disinfestation, with the exception of terminal disinfection carried out after a notifiable disease and the cleansing of verminous people.
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The following table shows the work done by the disinfectors:β€” Disinfection Rooms 32 Articles 582 Disinfestation Ants 10 Bugs 35 Cockcroaches 17 Beetles 7 Fleas 29 Lice 1 Articles for Destruction Dressings 91 Placentae 413 Household 31 70 MORTUARIES In accordance with the Council's decision the use of the mortuary in Hendon was discontinued and the service is now provided from the mortuary, North Circular Road, N.3. In the course of the year 565 bodies were received in the mortuary. EXHUMATIONS Licences for the removal of human remains under the Burial Act 1857 state, inter alia, "it is considered advisable that the Medical Officer of Health should be notified whenever such a licence is granted in order that he may be in a position to take any action that may be necessary in the interests of public health."
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Eight exhumations were carried out during the year and, where appropriate, were observed by a Public Health Inspector, to ensure compliance with the conditions in the licence. 71 MENTAL HEALTH SERVICES MENTAL HEALTH SERVICES Despite the imposed restraint in implementing the proposals contained in the 10-Year Plan, due to the National economic situation, it is nevertheless envisaged that forward planning of the mental health services will continue and from a revision of the priority of need will emerge realistic, albeit curtailed plans for long term development of the services. The provision of services to mentally infirm elderly still remains the first and most urgent priority. It is estimated that 12% of the population over the age of 65 i.e. something over 4,800 people are suffering from mental disorder which requires treatment. Over half of these old people are suffering from forms of mental illness which are reversible and most of which can be treated as efficiently as similar conditions in younger people.
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In addition the catchment hospital has become silted up with elderly people, many of whom no longer need the full facilities of a Psychiatric Hospital and whose discharge to community accommodation could make available beds urgently needed for the admission of acutely ill people in the community. The provision of a wide range of services including Day Hospital, Day Centres, Special Residential Hostels, Domiciliary Psychiatric Nursing and more intensive Social Work directed to the problems of the aged requires a concerted effort in which the local Health and Welfare Department has a key role. As mentioned in my previous report, plans for the development of the service include the provision of both Day Centres and Hostels for the elderly mentally infirm, but since these are not scheduled for commencement until 1968, Park House Hostel continues to be used on two days per week as a Day Centre under the direct charge of one of the Senior Social Workers. During 1967, the success of this experimental venture became apparent.
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An Occupational Therapy session under the guidance of the Council's Occupational Therapist was commenced in October and one of the benefits of this session has been the increased communication between the patients. The standard of work of some of the old people is much higher than might be expected β€” one old lady of over 80 years produces a constant supply of excellent cane trays. Stools, coffee tables, dish cloths, chamois car cleaners, mosaic ashtrays, leather work and toys are being made successfully and there has been surprisingly little wastage. A music programme of records was introduced with some success and a programme of guitar music is also planned. As a result of the increased socialization of these patients, a more adventurous programme was possible; one of the most successful outings was to the sea-side. Much of the success of the Day Centre would not be possible without the excellent help of the W.R.V.S. who assist with the supervision and care of the old people.
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Until such time as it is possible to extend the Day Centre arrangements for the elderly mentally infirm at Park House Hostel, the London Borough of Harrow continues to allocate four vacancies at their Marlborough Day Centre. Mental Subnormality The need for a hostel for trainable mentally subnormal adults has long been recognised and a 75 24 place hostel together with adequate facilities for adult training will be in the revised programming of capital projects. The restrictions in capital investment in the health and welfare service fortunately came after loan sanction had been granted for the purpose-built 40-place adult training centre at Mill Hill and the 10-place hostel in Finchley which will provide long and short term care for girls and boys between the ages of 3 and 16 years. It is anticipated that both these establishments will be completed and fully operational by the autumn of 1968. Some pride is felt in the achievements of the Borough's first 40-place adult training centre which opened on 10th January, 1967.
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The trainees soon adapted and their progress has been rapid. Emphasis has been directed to the practical training of the young adults. The social cohesion produced in the groups and the marked improvement in behaviour in some who were very disturbed has given great satisfaction to staff, the trainees themselves and their families. Admission and Discharge to Psychiatric Hospitals for the Subnormal The admission of the mentally subnormal child and young adult to psychiatric hospitals continues to present a major problem. The situation has become even more serious and although the closest contact is maintained with the catchment hospital, it is not possible for more beds to be made available, in consequence a great deal of time is spent seeking alternative placements through suitable private and voluntary agencies. The waiting list of those requiring permanent hospital care does not always reflect the true position, as throughout the year emergencies arise where immediate admission is necessary. Also, it is the practice of this department only to apply for hospital admission for those needing such care at the time.
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This reflects the fact that a comprehensive community care service provided for the subnormal considerably reduces the need for hospital admission. However, a study to ascertain future hospital needs will be undertaken as soon as possible. The number of patients awaiting admission for hospital care at the end of the year was ten of whom one was of extreme urgency. During the year, seventeen patients were admitted informally to psychiatric hospitals for the subnormal. There were seven cases of statutory admission. Twelve patients were discharged to community care. Short Term Care As the Borough will have no facilities for providing short-term care until the autumn of 1968, the arrangements for former years have continued. It is recognised that some relief to the family is necessary from the continual care of the subnormal member, and it is particularly essential that short-term care should be available when an emergency arises. However, the need unfortunately exceeds the availablity of places.
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Private placements are made or if these are not suitable, admission is arranged to the catchment hospital or other psychiatric hospitals able to offer vacancies. Short-term care during the summer period is always most difficult, and there have been some instances where placement has been impossible. The type of case where individual nursing care is needed can seldom be accommodated other than in a psychiatric hospital. 27 Patients were placed in hospital throughout the year and arrangements were made for 16 patients to be placed in private homes. The London Borough of Hillingdon continued to offer facilities for weekly boarding of the 76 subnormal at its Moorcroft Boarding Unit; children so placed attend the Junior Training School of that Borough. Holiday Camps Junior holiday camps were arranged by the London Boroughs of Enfield and Harrow and places were made available by those Boroughs for children to attend from the London Borough of Barnet. The adult camp was again arranged by the London Borough of Enfield, and this Borough was allocated twelve places.
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The holiday camps provide an invaluable service not only in giving relief to the parents during the summer holiday period, but also in achieving independence for the boys and girls attending, away from the normal home environment. Community Care for the Subnormal and Severely Subnormal Supervision in the Home The home visiting of children under the age of 16 and their families is undertaken by Health Visitors and a close co-operation is maintained with the Social Workers; the Mental Welfare Officer continues to be responsible for the care of those over the age of 16. Medical consultation with the Principal Medical Officer is available in either case. At the end of 1967 the number of subnormal and severely subnormal children and adults in Community Care was 447. Guardianship & Informal Foster Care At the end of 1967 the Council had only one patient for whom it was responsible under guardianship powers.
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Informal placements are made wherever practicable in order to avoid formal guardianship procedures, but there is still a need for the provision of private foster homes particularly for young mentally handicapped children. The number of patients in informal foster care or in homes or hostels run by voluntary organisations and private foster homes increased slightly in 1967 to 41. It is becoming increasingly difficult to obtain permanent placements where the home situation is such that it is either unsuitable or unable to contain a subnormal member of the family. Apart from the Guardianship Society there are a number of small private homes up and down the country that are used and annual visits are arranged to these patients. Personal knowledge of the homes used and a contact with patients out of the Borough is considered to be most necessary. Hostels for the Subnormal Work commenced in August, 1967 on the building of the short-term care hostel for 10 mentally subnormal children which should be ready for occupation by mid-1968.
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This will fulfil an urgent need and it is hoped to include a 24-place hostel for mentally subnormal adults in the plans for Mental Health projects during the next three years. In the meantime two places are available for adults at the London Borough of Brent Hostel at 191 Willesden Lane and one patient is resident in the Hertfordshire County Council Hostel at St. Albans. Junior Training Schools The two Junior Training Schools continue to play an important part in the Borough's Mental Health Service. New activities are being undertaken all the time and one that has been particularly enjoyed by the children is the introduction of swimming lessons. Various visits and outings have been arranged for the children to stimulate interest, and youth hostelling and camping are amongst the new ventures. 77 During the year a number of students have attended at the schools for teaching practice and numerous requests continue to be made by members of educational organizations both from this country and overseas to visit the schools.
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Special Care Units The Council's facilities in this respect are made available to contiguous Boroughs who have not been able to make provisions of their own and the distribution of places as laid down by the London Government Act has remained the same. Friem Baret Junior Training School London Borough of Barnet 58% London Borough of Enfield 12% London Borough of Haringey 30% Hendon Junior Training School London Borough of Barnet 61% London Borough of Brent 26% London Borough of Harrow 13% It cannot be ignored, however, that there are still a great number for whom no provision can be made and there is a very great need for the hospital services to provide Day Units for many of the more severely physically handicapped children and young adults whose prime requirement is nursing cars. Adult Training Centres Fieldways Adult Training Centre, Wellhouse Lane, Barnet, opened at the beginning of this year and by the end of 1967 there were 16 male and 19 female trainees attending.
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Difficulties had been experienced with transport arrangements and every effort is being made to shorten the travelling time. Despite the opening of Fieldways there are still insufficient places within the Borough for patients requiring training. It is hoped to absorb those awaiting admission in mid 1968 when the new Adult Training Centre at Mill Hill is opened. It is unlikely that the 45 trainees who attend the Edmonton, Uxbridge and Brentford Adult Training Centres can be accommodated within the Borough's own services until such time as the Adult Training facilities can be extended. Mental Illness Following the revision of the catchment areas of psychiatric hospitals, Naps bury, with effect from 1st April, 1967 became the sole psychiatric hospital for the mentally ill in the Borough. A close contact has always been maintained with this hospital and with the revision of the catchment area it has now been possible to arrange for four Mental Welfare Officers to attend regularly at Napsbury for meetings with Consultants and Social Workers.
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Social Work Service There has been a steady increase in the demand for the services provided and this entails a closer 78 integration of the medical, social and administrative services. Whilst the Mental Health Act, 1959 imposed a duty to appoint Mental Welfare Officers to act in psychiatric emergencies, this is no longer considered the main role of Social Workers in this field. Indeed it has been clearly demonstrated that emergency work can be markedly diminished by skilful and regular field work allied to early psychiatric referral. A fundamental principle of the Mental Health Service is that it will act as an educational and counselling agency disseminating skills through all the field staff of the Health and Welfare Department, and supporting as far as possible the work of other departments of the Council, of voluntary bodies and of all local community institutions. Thus a large number of people will be in a position to recognise disturbances in personality so that appropriate medical or other help can be obtained before serious illness supervenes.
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In addition to the community care and after care work of the field staff an emergency service is available at all times including Bank Holidays. Statistics relating to cases referred under the Mental Health Act are shown on pages 82 and 83. It is always difficult to present skills in terms of statistics but some idea of the volume of work undertaken by the officers and their supportive role in the community is represented in the fact that some 5,700 visits have been made during the year to both the mentally ill and mentally subnormal. In addition to social work the Mental Welfare Officers dealt with 207 informal and 303 statutory admissions to psychiatric hospitals. Hostel Park House Hostel continues to play an effective part in the rehabilitation of patients recovering from mental illness.
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During the year there was a change of Warden and as this coincided with the completion of a three year period of the running of the Hostel since its opening in the Autumn of 1964, an opportunity has been taken to study the results on residents in the Hostel and on those people who had passed through and who could be traced. The results of this study will be published in the coming year. Therapeutic Social Clubs It has not been considered necessary to organise a fourth therapeutic social club as the three existing clubs appear to be adequate to meet the need and have again provided a varied programme for those persons attending. The following attendances are encouraging to those who undertake the supportive roles in the clubs and who arrange enterprising activities to stimulate and help the interests of the members and enable them to achieve independent relationships outside the protective environment of the clubs.
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Park House 1021 Links 884 York Park 530 Hostel Accommodation Irrespective of the considerable number of persons who rehabilitate through the supportive services provided by the Social Workers in the field, psychiatric hospitals, voluntary agencies and the Borough's short-stay hostel, there were nevertheless 30 patients during the year who required long- 79 term hostels, and this Borough continues to use the following Associations who have a realistic approach to the problem of the long-term patient. Mental After Care Association S.O.S. Society Richmond Fellowship Jewish Welfare Board Day Centre for the Mentally III There are many services that are lacking for the young mentally ill the most important of which is Day Centre/Workshop facilities, and until such time as the financial position improves, the longterm planning for these establishments is necessarily curtailed. Those patients most urgently in need of this type of rehabilitation at the present time attend Day Centres through the courtesy of the London Boroughs of Willesden and Camden.
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Some Other Aspects of the Mental Health Services Drug Dependency This problem has received a good deal of publicity during the year; as far as this Department is concerned an essentially cautious approach has been adopted. So far the problem in this area does not seem to have reached too grave proportions, but since we are in close proximity to the centre of London it is easy for people to go into town to obtain drugs and to carry on activities associated with drug taking in an area away from their homes. Secondly it is possible for drug-takers to appear transiently in the Borough and then move on quite rapidly as soon as an interest is taken in them. In the past two years about 10 cases of heroin addiction have been personally known to the Department. The incidence of other drug-taking is not known although there has been considerable evidence that trafficking in and experimentation with L.S.D. and Indian Hemp has been going on in certain parts of the Borough.
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Requests for information have come from two main sources; firstly through the Education Department from Head Teachers and Principals of the Further Education Colleges and secondly from Youth Groups or adults who are running Youth Groups. Two "Teach-ins" were arranged for the Education Department, one for Heads of Secondary Schools and Principals of the Colleges of Education, which took place in October, and the second for representatives of the Common Rooms which took place in November. Each of these meetings was addressed by a Consultant Psychiatrist, by the Chief Inspector of Drugs at the Home Office and by a Senior Police Officer from the Drug Squad at New Scotland Yard. Experimental group meetings were held with young people at one of the Further Education Colleges and it is hoped to expand this work. The Principal Medical Officer (Mental Health) Dr. R.C.
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Greenberg met with a number of Youth Groups and other organisations to discuss with them the social effects of drugs and gain some understanding of the attitudes of young people themselves so as to discover the most efficient method of checking the present epidemic and preventing further spread. Information gained in this way was passed on to the Ministry of Health and the Department of Education and Science so that it could be used in preparing advice on this problem that both Government Departments intend to issue in the near future. Mental Health V/eek 1967 Mental Health Week, 5th to 11th June, 1967 was the second of three such weeks organised by 80 the National Association for Mental Health leading up to the 7th International Congress on Mental Health to be held in London in August, 1968. The theme this year was "Mental Health β€” Work to be done" and the intention was to attract people to undertake careers in the field of Mental Health. Mr.
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Christopher Mayhew was to have been the principal speaker for the opening meeting on 5th June, but he was unable to attend because of sudden developments in the crisis in the Middle East. His place was taken by Mr. L. King-Lassman LL.B., Middle Temple, Barrister at Law, who delivered a stirring address on the layman's attitudes and misapprehension in the field of Mental Disorder. A Brains Trust held on Thursday, 8th June was most successful and well attended by members of the public. A variety of interesting questions were put to the team of experts and the discussion which followed was both lively and informative; it was felt that benefit had been derived from this meeting. Members of the public were particularly encouraged to visit the two Junior Training Schools to enable them to acquire some understanding of the services provided and the skills that can be developed through training.
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Voluntary Bodies The Borough is particularly fortunate in having two very active and enterprising voluntary associations who organise functions and provide additional amenities for both the mentally subnormal and the mentally ill. Support is given by the administrative and social work staff in many of their undertakings to the mutual benefit of all concerned. 81 Number of persons under Local Health Authority care at 31st December,
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1967 Mentally 111 Elderly Mentally Infirm Psychopathic Subnormal Severely subnormal Total Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over M F M F M F M F M F M F M F M F M F (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) 1 Total number 1 2 73 159 13 28 2 14 6 92 65 52 45 87 86 725 2 Attending workshops/occupation training centres 2 2 5 6 10 3 20 15 42 35 46 42 228 3 Awaiting entry to workshops/occup.
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training centres 2 3 7 10 1 2 25 4 Receiving home training 5 Awaiting home training 6 Resident in L.A. home/hostel 3 4 7 7 Awaiting residence in L.A. home/hostel 8 Resident at L.A. expense in other homes/hostels 8 10 1 1 8 4 6 2 11 7 58 9 Resident at L.A. expense by boarding out in private household 1 1 10 Attending day hospital 1 5 6 11 Receiving home visits and not inc.
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in lines 2-10 (a) suitable to attend a training centre 12 20 7 20 59 (b) others 1 2 47 119 1 2 2 4 66 44 1 34 40 364 82 83 Cases of Mentally III Persons referred to Mental Welfare Officers during 1967 REFERRED BY:- UNDER 16 YEARS 16 YEARS AND OVER TOTAL MALE FEMALE MALE FEMALE GENERAL PRACTITIONERS 1 1 175 307 484 HOSPITALS, on discharge from IN PATIENT TREATMENT - - 56 80 136 HOSPITALS, after or during OUT PATIENT or DAY TREATMENT 1 - 33 46 80 LOCAL EDUCATION AUTHORITY 1 - 4 8 13 POLICE AND COURTS - - 29 16 45 OTHER SOURCES 3 - 118 162 283 TOTAL 6 1 415 619 1,
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041 Persons Under Mental Welfare Officers' Care At 31.12.67 MENTALLY ILL ELDERLY MENTALLY INFIRM SUBNORMAL TOTAL Under 16 years 16 years & over Male Female Male Female Male Female Male Female 1 2 62 145 13 28 181 151 583 WELFARE SERVICES WELFARE SERVICES SERVICES UNDER THE NATIONAL ASSISTANCE ACT, 1948 The Council's Welfare Services provide a range of services under Part III of the National Assistance Act, 1948 which extend to the care and wellbeing of persons in the community who, by reason of age, physical disability or other circumstances, have needs which cannot be met from other sources. The services include the provision of residential care for the elderly, temporary accommodation for homeless families, and a range of domiciliary welfare services. In brief it involves an ascertainment of need among the elderly and handicapped and directing efforts to enable the Council to meet that need or to utilise the assistance of voluntary bodies.
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Residential Accommodation The Council has 7 Residential Homes for elderly persons or other persons who, by reason of age, infirmity or other circumstances, require care and attention not otherwise available to them. Name of Home Number of Beds Disposition Beach Lodge, 66 Hendon Lane, Finchley, N.3. 32 Female The Cedars, Richmond Road, New Barnet. 38 Mixed The Leys, Barnet Lane, Elstree. 47 Female Morton Lodge, Ashfield Road, Southgate, N.14. 50 Mixed Redhill House, Burnt Oak Broadway, Edgware. 210 Mixed Storth Oaks, 1 Downage, Hendon, N.W.4. 31 Mixed Woodhill House, Kentish Lane, Essendon, Herts. 41 Mixed It is intended that the Council's homes be situate in various parts of the Borough so that persons admitted may, as far as possible, maintain some community association and continue contact with friends or relatives without undue difficulty.
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Redhill House, the former Poor Law residence, is programmed for closure in 1972/73 and the Ministry of Health has already given approval to a scheme to provide 4 new homes over 4 years which will enable the residents to be accommodated in units in different parts of the Borough. 87 During the year, the Meadowside Home in Holden Road, Finchley, N.12, was closed and later demolished. The 22 female residents were accommodated elsewhere, the staff moved to other premises and early in 1968 work will start on a new residential home for 50 residents. Improvements to the kitchen, dining hall, staff accommodation and the installation of a passenger lift, were completed at Woodhill House, and a new dining room extension, additional toilets and laundry facilities and an oil-fired boiler installation were provided at The Leys.
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The number of persons accommodated at the 31st December, 1967 for whom the Council was financially responsible was:- Barnet Council Homes 426 Barnet residents in other Local Authorities' Homes 61 Barnet residents in Voluntary Organisations' Homes 343 During the year, 130 persons were admitted to the Council Homes and 95 to voluntary organisation homes. In providing a residential service, it is important to give help to elderly or other persons for short periods, e.g., at times of crisis or for holidays, and 17 persons were so accommodated. The waiting list for admission to residential homes at the close of the year consisted of 31 men and 132 women. Until the new Meadowside home is open in the Autumn of 1969, no additional beds for.elderly persons will be available and names are therefore added to the waiting list only if there is an acute need.
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It is of interest to record that of the 130 persons admitted to the Council's homes during the past year, 53 were of an emergency nature and were persons whose names were not included on the waiting list. It is of particular significance that at the end of the year there were 27 voluntary organisation homes and 25 private homes for elderly or disabled persons registered with the Council; during the year, 7 were registered and 6 registrations were cancelled. Registration involves inspection visits to the premises to be carried out not less frequently than twice a year to ensure that the residents are being well cared for and the staff are suitable to undertake this work. A total number of 954 persons were accommodated, 744 in voluntary homes and 210 in private homes. Catering For some time, difficulty was experienced in obtaining cooks to work in the residential homes and even where cooks were employed, some support by other staff was found to be inevitable having regard to the application of the 40-hour week.
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In 2 homes, the position was 88 aggravated by a paucity of other staff and an acute staffing problem therefore arose. To ease the situation, deep frozen pre-prepared food was introduced for use in conjunction with conventional food stuffs. A wide variety of food permitted a 6 weeks' cycle of main meals and the techniques of cooking being simple to follow, cooking and serving time was reduced. The food was found to be attractive and with regard to the nutritional aspect, experiments by other Authorities have shown that it is possible to provide an acceptable, adequate, balanced, wholesome and palatable diet using unqualified staff. This pilot scheme will be watched with interest with a view to an extension of the system should the need arise. Homeless Families The Council has a responsibility to provide temporary accommodation for persons who, due to unforeseen circumstances, are in urgent need. It has extended this responsibility to provide accommodation for homeless families, accepting the principle of keeping the family together as a unit whatever the circumstances.
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Redhill Lodge, Burnt Oak Broadway, Edgware, accommodates 25 families, and Kelvedon, 27 Woodside Avenue, Finchley, N.12 accommodates 11 families. The number of persons resident in these units at the end of the year was:- Males (aged 16 and over) 28 Females (aged 16 and over) 35 Children (aged 5 to 15) 39 Children (aged under 5) 55 In addition there is a small reception unit at Redhill House. Valuable work is carried out by the staff of the Department and where appropriate the assistance of other Council Officers, and voluntary bodies is obtained: all work in harmony to set families on a new road to personal independence. During the year, 42 families totalling 151 persons were admitted and 44 families, totalling 175 persons, discharged.
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The Elderly Social Welfare Officers, together with other Officers of the Department and the Council and voluntary bodies, advise on the wide range of activities and services available. It is a notable feature of the community spirit of the residents of this Borough, that many organisations interest themselves, and give active help and support to elderly persons, and in appropriate cases the Council acknowledges this work by giving financial support. Clubs, day centres, work centres, and a wide range of social, educational and occupational opportunities are available, all contributing a part towards the wellbeing of elderly persons. 89 The Council itself plays a complementary role, having established a day/work centre at Etchingham Park, Finchley, N.3. The maximum number that can be accommodated in the day centre is 15 members; many of those who attend do not do so every day for various reasons.
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Some attend every day, others as little as one or two days per week, and this arrangement enables the benefit of attendance being spread over a larger number of persons; despite this there was a long waiting list at the end of the year. Many of those attending have some additional disability, other than infirmity associated with old age and the demands on the staff are constant and varied; nevertheless the staff cope with these demands with ability and an understanding of individual needs necessary in the Welfare Services. Although the space allocated for use as a work centre can accommodate 40 persons, part of this room is utilized for "socializing" between workers and members of the day centre and the number of workers is reduced accordingly; however, to satisfy the wishes of some workers and to complete work operations, both morning and afternoon sessions are operated. The source of employment is constantly under review and effective supervision of workers is essential to ensure the proper standard of work being returned to the employers.
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It is intended to extend the day centre principle whenever space and opportunity permits, and in fact, early ne xt year, the Health Clinic in Claremont Road will afford day care for some 10 persons on two days per week. A combined meals kitchens and old people's centre is now established at Brookhill Road, East Barnet, with the co-operation of the Women's Royal Voluntary Service and the East Barnet Old People's Welfare Association. This centre is housed in a converted building, previously occupied by the former East Barnet Urban District Council library. The meals-on-wheels service provided by the Women's Royal Voluntary Service throughout the Borough, plays a vital part in maintaining the health of elderly people and enabling them to remain in the security and comfort of their own home. 48,620 meals were delivered during the year. Not all parts of the Borough receive a 5 day service, but this is being extended as and when manpower and other resources allow. The Council subsidises the cost of the meals supplied.
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The contribution by luncheon clubs operated by the Women's Royal Voluntary Service, Old People's Welfare and other Associations, plays no less an important and supportive role to old people. Through this source, a total of 9,651 meeds were served in five different parts of the Borough, on one, two or three days per week. Notwithstanding the services outlined above, with an elderly population of 43,760, there is an increasing demand for a service to the community to be based on a framework of affluence, rather than subsistence, and therefore, a hard look at priorities must continually take place in view of the increasingly high cost of providing institutional care, whether within a hospital or a local authority setting. The Blind, Deaf or persons with a substantial physical handicap The Council has a duty to promote the welfare of all persons who are blind, deaf, or otherwise substantially or permanently handicapped by illness, injury or congenital deformity.
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In all these 90 services the emphasis is placed on meeting the social, vocational, recreational and rehabilitative needs of these persons; at all times striving to assist them to retain their independence at home with their families, or with their close support. Blind and Partially Sighted Persons The total number of persons registered at the 31st December, 1967, was made up as follows Male Female Total Under 5 years of age - 2 2 Aged 5 years to 15 years 9 4 13 Aged 16 years to 20 years 6 6 12 Aged 21 years to 64 years 90 86 176 Aged 65 years and over 138 360 498 243 458 701 Within these figures there are 16 persons working under sheltered conditions, 7 being employed in workshops for the blind, and 9 workers engaged at home in occupations ranging from physiotherapy to knitting.
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It is worthy of mention that 73 persons were employed under ordinary conditions, i.e. in the general community earning their own living. A total of 25 males and 69 females were newly registered during the year. Qualified Social Welfare Officers for the Blind are employed to assist this class of handicapped persons by promoting their general social welfare, supplying occupational and recreational opportunities, and by ensuring that those able to benefit by training and rehabilitation are given the chance to do so. The Partially Sighted Register comprised 164 persons of whom 31 were working and 96 were aged over 65 years; 34 were registered during the year. These persons receive the full support of the Social Welfare Officers in the same way as the registered blind. Handicraft Classes were held in different parts of the Borough each week, and dancing and cookery classes formed a feature of other social activities; 66 persons participated in an Assisted Holiday Scheme during the year.
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The needs of the deaf and blind are very demanding and the Council shares with neighbouring Boroughs the time of a Welfare Officer for this service. The Deaf and Hard of Hearing The Welfare Officer for the Deaf is concerned with counselling and interpretation for the deaf without speech, undertaking case work, and advising other social workers of the special problems of the Deaf. Special aids have been issued where appropriate, one of which is the Silent Door 91 Bell Device linked to the lighting circuit within the home, this being of particular help. Voluntary organisations provide spiritual and social activities, and the Council acknowledges the opportunities given to the deaf by the Royal Association in Aid of the Deaf, through its many Centres. Contact is maintained with Hard of Hearing Groups at Barnet and Hendon, both of which flourish under active leadership, and having a membership totalling 152 persons.
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Physically Handicapped Persons This group includes spastics, epileptics, persons suffering from multiple sclerosis, muscular dystrophy, arthritis, the residual effects of poliomyelitis, tuberculosis, and other diseases and injuries. The Register continues to increase, and the number at the end of the year was 1,166 persons, made up as follows General Classes of Handicapped Under 16 years of age 14 Aged 16 years to 64 years 511 Aged 65 years and over 641 1,166 The Council has a daily work centre at Heriot Road, Hendon, where up to 30 persons attended durinig week-day mornings. The co-operation of local firms is sought to obtain work of a suitable nature and a variety of assembly jobs are carried out by those attending. Council transport is used to convey some of the handicapped to and from the Centre.
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A new Rehabilitation Centre in Deansbrook Road, Edgware, is expected to be completed early in 1968. The purpose of the centre is to provide a rehabilitation service for blind, partially sighted and all classes of physically handicapped persons, including the deaf. Particular emphasis will be placed on assisting those whose disability is of recent origin and who after receiving hospital therapeutic treatment are returned to the community and who will benefit from the opportunity to engage in various work operations or learning communication, mobility or housecraft methods. Its opening is eagerly awaited to enable a greater contribution to be made to assist blind and handicapped persons towards a greater all round independence. The British Red Cross Society held afternoon craft classes each week at Edgware, Hendon Finchley and High Barnet. This service is much valued by the Council, and appreciated by all who attend. A weekly Choral Class, attended by handicapped persons, was held in North Finchley during school terms; each year the choir attends a festival.
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Wherever possible the Council extended its transport support to voluntary bodies to assist in social activities and holiday schemes; in some cases no charge was made, and in others a 92 limited mileage was allowed, without charge. During the year, 103 persons were assisted on the Council's holiday scheme. The frequent visiting advisory and counselling service performed by the Social Welfare Officers is of importance, together with the practical assistance given to those persons in need of help by way of the loan of aids to daily living and in this connection 136 such aids were issued. In addition, 64 adaptations to properties were made in an endeavour to maintain people's independence at home. Miscellaneous The Cbuncil has a duty to protect the movable property of persons admitted to hospital, residential, or other accommodation under Order of the Court, where there appears danger of loss; action was taken in four cases during the year.
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The Department accepts gift furniture, which is distributed to needy persons, but is particularly useful in assisting families rehoused from the Homeless Family Units. Voluntary Organisations Several references have been made above to the valuable contribution made in many aspects of the welfare service by voluntary organisations, other bodies, and some individuals, all of whom are concerned for the wellbeing of those who need support to maintain a reasonably independent existence in the community. It is of primary importance that the Council's Officers maintain a close and harmonious working relationship with the working partners with whom 'the Council is associated in this task. Their efforts are gratefully acknowledged, and wherever possible and needed, financial, or other support, is rendered. 93 PERSONAL HEALTH SERVICES PERSONAL HEALTH SERVICES Existing Clinic Provision A table setting out full information in respect of the Council's clinics and a key to the services provided will be found on page 115.
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General Practitioners/Domiciliary Staff Attachments The attachment of Health Visitors to General Practitioners was increased, whilst the complete attachment of midwives to General Practitioner Obstetricians was effected in September. Health Visiting The full complement of Health Visitors was retained during the year with only a small number of staff changes. Three student health visitors successfully completed their course and were taken on to the established staff and two health visitors were appointed specifically to deal with elderly people in two areas of the Borough where there is a heavy proportion of elderly persons. Health Visitors have taken a large part in the programme of direct health education and have given talks to groups of mothers in centres and to student nurses during their state registration training. They also began teaching in five more junior schools and three more senior schools. The amount of time given to student nurses from hospitals in the Borough by health visitors has steadily increased.
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It is usual for a student to spend a day with a health visitor on domiciliary duties and then return to the hospital for discussion with a member of the health visiting staff. The introduction of health visitors to Edgware General Hospital Geriatric Unit was a happy experience lasting for eight months during which time relationships were improved, and to cement this beginning, it was decided to second one health visitor with a special aptitude and interest in the care of the elderly to the unit for five sessions per week. She conveys the needs of the elderly known to the health visitors in the catchment area to the hospital staff and receives information in turn. Many difficulties of communication have been eliminated and this is proving to be a very worth while arrangement. The Council for Health Visitors Training referred two of the staff from a London College to the Borough to observe the administration of the public health nursing services prior to arranging management courses.
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The following tables show (a) the number of cases of various categories visited by Health Visitors and (b) staff attendance at Clinics. 97 (a) Home Visiting First Effective Total Effective Total No. Access No. of Visits at request of G.P. Or Hospital Expectant Mothers 1030 1717 382 β€” Children born in: 1967 5084 11435 2598 β€” 1966 4401 9280 1814 β€” 1962-65 6944 14179 2582 β€” Persons aged 65 or over 1990 4733 761 690 Mentally disordered 122 412 54 45 Persons discharged from Hospital (excluding Mental Hospitals) 229 297 35 162 Infectious Diseases (other than T.B.)
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60 110 42 Other Visits as Health Visitor 952 1699 164 β€” Total as Health Visitor - 44252 8638 897 Cases seen as School Nurse - 1924 348 β€” (b) Attendances at Clinics Total number of attendances by Health Visitors at Local Health Authority Clinic Sessions 3518 Total number of attendances by Clinic Nurses at Local Health Authority Clinic Sessions 2153 Attendances by Health Visitors at School Health Services Clinic Sessions 409Β½ Attendances by Clinic Nurses at School Health Services Clinic Sessions 1676 Prevention of Homelessness - (Problem Families) Intensive case work with problem families continued to be undertaken by two family case workers. Families at risk of homelessness were successfully helped and progress was made in cases where there were marital and other problems. Support was given to the Warden at Redhill Lodge Hostel, who did excellent rehabilitative work with the resident families. The whole atmosphere within the Hostel improved greatly and a feeling of team spirit began to prevail.
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98 Care of Mothers and Young Children Notification of Births Number of births in the London Borough of Barnet during 1967 as adj usted by inward and outward transfers: (i) Live Births (a) Domiciliary 499 (ii) (b) Institutional 4,110 4,609 (ii) Still Births (a) Domiciliary β€” (b) Institutional 64 64 4,673 Ante-Natal and Post-Natal Clinics Care is given either in the Clinics or in the patient's own home by the Midwife. Ante-Natal and Post-Natal Clinics are provided at 12 Clinics and the following tables show the numbers of ante-natal, post-natal, relaxation and mothercraft Clinic Sessions held. Ante-Natal Clinics (combined with Post-Natal) Clinic Total No. of Attendances No.
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of Sessions held Average attendance per Session Ante-Natal Post-Natal Oak Lane 314 6 48 6.7 Torrington 282 18 52 5.8 Central Hendon 241 10 49 5.1 Childs Hill 219 4 49 4.6 Mill Hill 442 13 52 8.8 Watling 153 1 48 3.2 West Hendon 723 2 52 13.9 Edgware 129 2 41 3.2 Sutton Road 461 17 52 9.2 Holly Park 58 4 52 1.2 Oakleigh Road 75 4 52 1.5 Claremont 14 β€” 36 0.4 TOTALS 3,111 81 583 5.5 A total of 681 women attended Clinics in the Borough for ante-natal examination and 48 for post-natal.
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99 Attendance at Relaxation and Mothercraft Clinics Clinic No. of Sessions held Total No. of Attendances Average Attendance per Session Relaxation Broadfields 29 150 5.2 Central Hendon 1 3 3.0 Oak Lane 3 8 2.7 Combined Mothercraft and Relaxation Oakleigh Road 50 91 1.8 Mill Hill 47 342 7.3 Childs Hill 29 145 5.0 Edgware 45 187 4.2 Watling 38 127 3.3 West Hendon 41 223 5.4 Central Hendon 56 281 5.0 Oak Lane 42 208 5.0 Torrington 94 689 7.3 Sutton Road 51 134 2.6 Vale Drive 41 254 6.2 TOTALS 567 2,842 5.0 Congenital Malformations Notifications of congenital malformations are received from Hospitals,
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General Practitioners and Domiciliary Midwives and details of these are passed to the Registrar General. During the year 64 cases were notified in Barnet and the children's names are added to the "AT RISK" Register to ensure that they are examined at the appropriate time and that treatment is given where required. Child Welfare Centres The following table shows the sessions held and attendances at each of the Child Welfare Clinics:- 100 Clinics No. of Sessions Total Attendance Average Attendance No. of cases seen by A.M.O. No. of cases referred elsewhere Infant Welfare Sessions Claremont 50 1208 24.2 532 5 Colindale 52 1747 33.6 567 β€” Edgware 100 2700 27.0 986 16 Broadfields 51 2196 43.1 650 _ Watling 102 3762 36.
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9 1154 β€” Central Hendon 142 5157 36 3 2017 β€” West Hendon 98 2456 25.0 939 3 Childs Hill 100 4144 41.4 1152 19 Temple Fortune 63 2441 38.8 583 7 Holders Hill 48 1622 33.8 477 _ Mill Hill 102 3331 32.7 1422 β€” Sanders Lane 32 809 25.3 266 _ Torrington 103 4015 38.9 1157 β€” Oak Lane 78 2376 30.5 979 2 Essex Park 103 3727 36.2 1058 _ Oakleigh Road 51 1779 34.9 587 _ Holly Park 55 1244 22.6 709 _ Sutton Road 52 2196 42.2 797 β€” St.
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Marks 12 319 26.6 214 1 St.
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Stephens 52 1305 25.1 445 6 Osidge 156 4591 29.4 1958 β€” Ouaker Hall 24 352 14.7 162 2 Vale Drive 51 1072 21.0 536 14 East Barnet 100 4033 40.3 1784 9 Dollisfield 23 470 20.4 296 11 766 Finchley Road* 50 754 15.0 364 β€” 108 Watling Avenue* 7 63 9.0 55 - Sessions without a Doctor Dollisfield 28 305 10.9 Holly Park 47 383 8.2 β€” β€” Inglis Barracks 42 596 14.2 β€” β€” Oak Lane 25 403 16.1 β€” β€” Temple Fortune 39 873 22.4 β€” β€” Redhill Lodge 6 88 14.7 β€” β€” St.
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Marks 12 294 24.5 β€” β€” Sanders Lane 16 277 17.3 - - Toddlers Sessions Sutton Road 7 59 8.4 59 Watling 10 68 6.8 55 β€” West He ndon 2 26 13.0 7 β€” Oak Lane 51 745 14.6 564 1 Claremont 1 25 25.0 11 β€” Holly Park 1 13 13.0 13 - Oakleigh Road 3 33 11.0 31 - Developmental Clinics Broadfields 6 40 6.7 40 Mill Hill 7 91 13.0 54 β€” Temple Fortune 32 256 8.0 246 β€” Childs Hill 12 55 4.6 55 β€” Dollisfield 4 15 3.8 15 - Vale Drive 10 32 3.2 32 β€” Sutton Road 1 12 12.
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0 12 - TOTALS 2219 64558 29.1 23040 96 * General practitioners attachment Number of children who attended during 1967: Born in 1967 4290 Born in 1966 3774 Born in 1962/65 4767 TOTAL 12831 101 Mothers' Discussion Groups Discussion Groups in operation at the end of the year were as follows: Vale Drive Clinic Torrington Park Clinic Brunswick Park (Osidge) Clinic Mill Hill Clinic Childs Hill Clinic Midwifery There was a reduction in the number of home deliveries conducted by domiciliary midwives, 491 deliveries taking place with medical aid being summoned in 21 cases. In addition 571 early discharges from hospital were dealt with. 29 pupil midwives received their district training in the Borough, 6 living with midwives and the others in the District Home at Gervase Road, Edgware. 3 midwives attended statutory refresher courses.
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2 new Infant Resuscitation Outfits were purchased and all the midwives were instructed at University College Hospital in their use. The hospital staff were most helpful and made the midwives very welcome. A model infant head was purchased to facilitate the teaching of resuscitation. During the year the Central Midwives Board issued a directive on the performing of episiotomies by midwives. All the staff concerned went to Edgware General Hospital and received instructions on the method suggested by the Board. Again every help was given by the hospital. During the year all Midwives were attached to General Practitioners and attended the ante-natal and post-natal clinics of Doctors who wished to see their maternity patients apart from the general surgery. Some midwives and pupil-midwives made a visit to Victoria Maternity Hospital, Barnet, to see the new Premature Baby Unit.
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The Matron of a Singapore hospital spent a week in the Borough studying the administration of the domiciliary midwifery services as part of her administrative course at Edinburgh University. Home Nursing In October it was de cided to fill two vacancies for home nurses by appointing nursing auxiliaries and to commence a pilot scheme for six months, whereby the auxiliaries, under the supervision of a senior home nurse, would relieve home nurses in one part of the Borough of bathing duties so that the home nurses' skills could be utilized to the full. Also in October one home nurse was attached full time to a group of general practitioners, 102 while a second nurse commenced liaison with another group practice. These two methods of co-operation will be watched closely so that it may be decided which of them provides the better service to the patient.
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An approach was made to one of the two large hospitals in the Borough with a view to consideration being given to planned early discharges of general cases in the future and in my next Report I will comment further. During the year the number of requests for blanket baths and general care of patients increased. The major part of the home nurses' work was with the elderly and chronic sick. The use of disposable enemas, syringes, etc. has eased the work considerably and the introduction of an evening rota system from 6-9 p.m. daily has helped spread the work load throughout the day and evening. Home nurses are afforded the opportunity to discuss their cases with other members of the Department's staff, such as health visitors, clinic nurses and visitors to the elderly and these discussions are proving to be of great benefit. No. of cases nursed 3,503 No. of patients under 5 at first visit 55 No.
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of patients 65 or over at first visit 2,309 Marie Curie Memorial Foundation The Authority continued to act as agents for the Foundation and during the year 14 patients were provided with a day and/or night nurse to assist in their care. In one case a haemoductor apparatus was borrowed from the Foundation. Loan of Nursing Equipment Nursing equipment continued to be loaned by the British Red Cross Society acting as agents for the Authority. Larger items of equipment required were purchased by the Authority. Incontinence Pads and Clothing Approximately 45,000 incontinence pads and 250 pairs of waterproof pants were provided free of charge to patients in need. Home Help Service The staff structure of the service was altered when the Home Help Organiser retired. One of the three Area Organisers was appointed Senior Organiser and an Assistant Area Organiser was appointed.
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The overall responsibility for the service was delegated to 103 the Principal Nursing Officer with a view to increasing the co-ordination between this service and the nursing services. The service operated from Central Office and two Divisional Offices. There was still an acute shortage of Home Helps in some parts of the Borough and informal talks were given to Women's Organisations by the organising staff for the purpose of recruitment but the number of applications for employment was disappointing. During the year there were fewer applications than in the previous year from patients for maternity help but there was an increase in the number of cases over 65 years of age. The following shows the type of assistance given during the year.
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Number of cases Aged 65 or over in 1967 Age under 65 in 1967 Total Chronic sick or Tuberculosis Mentally Disordered Maternity Others 1572 148 11 274 604 2609 Neighbourly Help Service 27 Neighbourly Helps were employed at the end of the year and were providing assistance to 27 individual households. Day Nurse'ries During the year, the three day nurseries continued to operate to full capacity and 15 more places in the York Park Nursery were made available to Barnet children by the gradual withdrawal of Borough of Brent cases. It was still the policy to admit priority cases, i.e. children from homes where the conditions are unsatisfactory from the health point of view, children of unsupported mothers, widows and widowers, and children who are handicapped either physically or mentally. Staffing at the nurseries remained fairly constant and at no time during the year were admissions curtailed because of shortage of staff.
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The following table shows the attendance at the individual Nurseries during the year- Name of Day Nursery No. of approved places Children on Register at 31.12.67 Attendances for the year Average daily attendance 0-2 2-5 0-2 2-5 York Park 60 44 19 2904 9249 ♦7.8 Kingswood 50 43 11 2570 8826 45.0 Wood Street 55 41 10 1946 7541 37.3 TOTALS 165 128 40 7420 25616 130.1 Figures include Londor Borough of Brent cases β€” allocated places at York Park during 1967. 104 Nursery Nurse Training During the year consultations were held between the Authority and the Ministry of Health regarding the possibility of training nursery nurse students within the Borough.
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I am grateful for the support and encouragement received from the Ministry and for the assistance given by the Chief Education Officer and the Barnet College of Further Education. It was decided that the proposition was a practical one and would meet the staff needs of those Departments of the Authority employing nursery nurses; furthermore it would reduce the travelling time of students who would otherwise receive training at the Tottenham Technical College. A tutor was to be appointed early in 1968 and it was hoped to recruit up to 36 students for a 2 year period of training who would all be college based. Private Day Nurseries and Registered Child Minders Applications for registration have steadily increased in number. Appropriate reports are submitted to the Health and Welfare Committee following initial visits by officers of the Borough Council. Regular supervisory visits to all day nurseries and child minders were paid throughout the year. At the 31st December 1967 there were 30 registered child minders and 46 private day nurseries.
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Clinics (or the Elderly A total of 57 sessions were held at West Hendon and Watling (Edgware) Clinics and 1407 attendances made, this showing an increase of 279 attendances over the number made in 1966. Chiropody In the former Middlesex County Council districts, a directly provided clinic and domiciliary service was continued and in the former Hertfordshire County Council districts, treatment continued to be provided at chiropodists' surgeries or through domiciliary visits. Agency arrangements with voluntary bodies continued, and in September approval was given to a further increase in the number of sessions held by the British Red Cross Society's Centre in St. Albans Road, Barnet, in view of the increasing demand for the service in that district. Whilst this continues to be a service very much understaffed, there was an increase in the number of persons treated as compared with 1966.
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105 Category Persons provided with Treatment Directly by the Authority (including those treated by private chiropodists on behalf of the Authority) Through arrangements with Voluntary Organisations Elderly persons 2792 656 Physically handicapped 20 β€” Expectant and Nursing Mothers 24 Schoolchildren 33 β€” Children under 5 years 5 - TOTALS 2874 656 Recuperative Holiday Homes During the year 81 persons were admitted to recuperative holiday homes. There were also 31 applications approved but later withdrawn. Recommendations came in the main from General Practitioners, whilst others were received from hospitals and the medical staff of the Department Registration of Nursing Homes In accordance with the provisions of the Public Health Act 1936 and the Nursing Homes Act 1963 and Part III of the Mental Health Act 1959, the Re gistration and Inspection of Nursing Homes is the responsibility of the Local Health Authority. There are 15 Nursing H6mes registered with the Borough. Name and Address No.
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of Beds St. Mary's Maternity & Medical Nursing Home, 5 Maternity 46 Sunny Gardens Road, 6 Surgical, Medical & Chronic Hendon, N.W.4. Brent Nursing Home, 32 Medical & Chronic 4-6 Heather Gardens, N.W.ll. Cartref, 2 Chronic 196 Watford Way, N.W.4. Edgware Nursing Home, 13 Medical & Chronic 36-38 Orchard Drive, Edgware, Middx. 106 Registered Nursing Homes (Continued) Name and Address No. of Beds Clovelly, 19 Medical & Chronic 81 Torrington Park, N.12. Arkley Lawn Niirsing Home, 25 Surgical, Medical & Chronic Arkley, Barnet. Ellern Mede Nursing Home, 34 Chronic Totteridge Common, N.20. Preston Lodge Nursing Home, 16 Medical & Chronic 38 Station Road, New Barnet.
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Braeside House Nursing Home, 9 Medical & Chronic 76 Park Road, New Barnet. Bedford House, 23 Medical & Chronic Marshall Estate, Hammers Lane, N.W. 7. Convent of St. Mary at the Cross, 48 Incurable Orthopaedic Hale Lane, Edgware. Inverforth House, 139 Medical & Surgical Manor House Hospital, North End Road, N.W.ll National Kidney Centre, 3 1 Fairholme Gardens, N.3. Stuart House Nursing Home, 8 Medical 66 West Heath Road, N.W.3. Northumberland House, 30 Mental 237 Ballards Lane, N.3. 107 Nurses' Agencies The three Nurses' Agencies, Harley Nurses, Rupert House, Stonegrove, Edgware. The Hertford Nurses' Bureau, 45 Manor Road, Barnet. The Finchley Nurses Co-operation, 24 Eton Avenue, N.12.
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were inspected during the year and their licences renewed. A new agency, Nul-Sal Agency, 335 Long Lane, Finchley, N.2. applied for a licence. The premises were inspected and found to be satisfactory, and a licence was granted. Priority Dental Services The number of expectant and nursing mothers and children under five receiving dental treatment at clinics has gradually declined as a number of patients now seek free treatment from their own private dental practitioners. Attendances and Treatment Children under 5 Expectant and Nursing Mothers First Visit 616 130 Subsequent Visits 687 268 Total Visits 1303 398 Number of additional courses of treatment commenced 22 15 Treatment Provided: β€” β€” Number of fillings 1129 340 Teeth filled 896 270 Teeth extracted 259 62 General Anaesthetics 117 6 Emergency visits 41 19 Patients X-rayed 2 25 Patients treated by scaling etc.
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81 80 Teeth otherwise conserved 268 β€” Teeth root filled 7 Inlays/Crowns β€” Number of courses of treatment completed during the year 351 58 Prosthetics Patients supplied with full upper or full lower (first time) 14 Patients supplied with other dentures 22 Number of dentures supplied 36 108 Anaesthetics General anaesthetics administered by Dental Officers 2 Inspections Children under 5 Expectant and Nursing Mothers Number of patients given first inspections 522 94 Number of patients who required treatment 294 79 Number of patients who were offered treatment 294 79 Fluoridation of Public Water Supplies No progress could be made with the fluoridation of local public water supplies for the measure depends upon approval of all Authorities who share the same water supply and the user Authorities of the three sources of water supplies in Barnet have not all agreed with the policy of fluoridation.
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Tuberculosis The Finchley Chest Clinic, High Road, Finchley, N.12, closed in August 1967 and the Borough is now served by two Chest Clinics: 1. Edgware Chest Clinic (attached to Edgware General Hospital) Chest Physician: Dr. H.J. Trenchard. 2. Barnet Chest Clinic (attached to Barnet General Hospital) Chest Physician: Dr. J.G. Hounslow. On the closure of Finchley Chest Clinic, arrangements were made by the Regional Hospital Boards for patients to be based on other Chest Clinics and those arrangements have been proved satisfactory insofar as the Authority is concerned. Some concern had been expressed at the possible loss of X-ray facilities in the Finchley area, but this matter has been resolved by the holding of one evening session per week for routine X-rays for general practitioners at Finchley Memorial Hospital.
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There are general medical outpatient clinics with two visiting consultants, each attending once a fortnight, at the Finchley Memorial Hospital and the North West Metropolitan Regional Hospital Board have indicated that should the pressure on this outpatient department increase, they would be prepared to increase the number of doctor sessions available. The Medical Director of the Mass Radiography Service has stated that in the event of the number of patients referred to the Finchley Memorial Hospital being greater than anticipated, he would be prepared to set up a mobile unit for either a morning or an afternoon per week. The Health Visitors and T.B. Visitors continue to carry out social visiting and act as a liaison between the patients and the chest physicians. 109 1. Number of cases of tuberculosis under treatment or supervision at 31st December 1967: Respiratory N on-Respiratory Men Women Children Total Men Women Children Total 1830 1326 85 3241 66 77 6 149 2.
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Number of cases of respiratory tuberculosis (whether notified or not) included under Section 1 above which were new to the Clinics (but exluding transfers from other Clinics) during the year ended 31st December 1967: * Classification Non-Bacteriologically Confirmed Bacteriologically Confirmed Men Women Children Total Men Women Children Total Group I 37 25 10 72 9 5 - 14 Group II 8 1 - 9 8 4 - 12 Group III 2 - - 2 10 2 1 13 Totals 47 26 10 83 27 11 1 39 3. Number of cases of non-respiratory tuberculosis included in 1 above, new to the Clinics (but excluding transfers from other Clinics) during the year ended 31st December 1967: Men Women Children Total 7 11 1 19 4.
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Number of cases included in 1 above, whose broncho-pulmonary secretion was positive during the year 60. * The three sub-divisions of new respiratory cases are estimated as as follows from the standard P.A. film: Group I Total area of disease not exceeding one third of one lung in aggregate. Group II: Total area of disease not exceeding two thirds of one lung in aggregate. Group III: Total area of disease exceeding (including miliary disease) two thirds of one lung in aggregate. Tuberculous pleural effusions, pleural thickening without obvious lung involvement and enlarged hilar glands Eire placed in Group I. Once again I wish to express my appreciation of the work carried out by the physicians in charge of the clinics and for statistical information received. Furthermore I wish to acknowledge their cooperation and assistance at all times.
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110 The Care of the Unsupported Mother The Authority has one Mother and Baby Home, Guilford House, and this provides 14 ante-natal beds and 14 postnatal beds with 14 cots. No deliveries take place in the Home. Of the 160 referrals to the Department, 40 were admitted to Guilford House, 32 were admitted to other Local Authorities' Homes and 88 were not admitted. In addition, 91 cases were admitted to Guilford House from other Local Authorities. Family Planning Early in the year the Council approved the setting up of a domiciliary family planning service as a further extension of the service provided through the medium of the Family Planning Association. Some time elapsed before a doctor and nurse were appointed by the F.P.A, but by the beginning of September the domiciliary service was ready to be put into operation and General Medical Practitioners throughout the Borough were informed. The estimated cost of this service is Β£10.0.0.
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per patient per annum and the cases referred are vetted by a senior medical officer of the Department. By the end of the year, four families had been referred. The domiciliary service covers the need of persons unable to attend the F.P. Clinics and especially of those who otherwise would not take any action. The cost of large families to the community can be considerable and many are problem families burdened by poverty and ill health due to unwanted pregnancies occuring in quick succession, with the resulting lowering of standards. The parents may be socially maladjusted and mentally incapable, many themselves being products of broken and needy homes, and unable to care adequately for their children. These families are often below the Ministry of Social Security poverty line and the children find themselves physically, mentally and educationally at a disadvantage compared with children from small families. Housing problems are very real for these families, particularly as there is a shortage of houses with more than three bedrooms.
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The problem of uncontrolled fertility can be alleviated by persuasion and suitable educational methods but to be fully effective the necessary advice must be brought within the reach of those couples most in need of it. Cervical Cytology This diagnostic service continued during the year at the three clinics, Torrington, Childs Hill and East Barnet. A fourth weekly clinic was started at Watling Clinic at the beginning of May, this being made possible by the ability of Edgware General Hospital to provide the necessary technical facilities for the reading of up to 20 smears a week. Owing to staffing and accommodation difficulties at Barnet General Hospital, there was towards the middle of the year, a progressive contraction of cervical cytology work and the sessions at Torrington, Childs Hill and East Barnet were reduced from one a week to one a fortnight. 111 19626 patients attended for the first time during the year. In every case the patient and her doctor were notified of the result of the test.
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There were four positive results and these were referred through their General Practitioners to a Gynaecologist for further investigation. Some women were referred by their own General Practitioners but most attended of their own volition Many heard of the service through their attendance at Women's Organisations or from notices in the local press. Posters have been placed in clinics, libraries and other Council establishments, and in some doctors' surgeries. Near the end of the year the service was extended to allow for all women attending the the cervical cytology clinics to have a full examination of the breasts, abdomen and pelvis. Attendance at Cervical Cytology Clinics Clinic No. of Sessions Held Total No.
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of Attendances Average Attendance per Session Torrington 34 496 14.6 Childs Hill 30 364 12.1 East Barnet 32 406 12.7 Watling 34 453 13.0 TOTALS 130 1719 13.2 Vaccination and Immunisation In January a circular was received from the Ministry of Health in respect of new arrangements for payments to general practitioners for vaccination and immunisation records. These arrangements require general practitioners to send to the Local Executive Councils the necessary records and Which will permit of the Executive Councils making the appropriate payment of permitted fees. The Executive Councils submit to the Local Authority the necessary information which ertables the Statistical returns required by the Ministry of Health to be completed. Prior to the introduction of this circular the Local Authority paid a fee of 5/- to each general practitioner submitting details of vaccination and immunisation. A further Ministry of Health circular in April altered the arrangements for smallpox vaccine distribution.
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General practitioners in the Borough were informed that vaccine is now stored at main clinics in the Borough and that supplies may be drawn therefrom between 9 a.m. and 5.30 p.m. Monday to Friday. Vaccine is sent by post where requested. Immunisation in Childhood The Ministry of Health notified the Authority in December that the Joint Committee on Vaccination and Immunisation had reviewed the existing schedules of immunisation in childhood and had recommended that these should be replaced by a single schedule. The 112 Ministry stated that circulars to Local Health Authorities and to Executive Councils were being prepared and were expected to be dispatched early in 1968, and the Authority was being given information in advance, in order that consideration might be given to the changes that would be introduced when the schedule was adopted. The changes in the schedule, which affect the procedures in various ways, are numerous and I expect to report further on this subject in 1968 after the circular referred to has been received from the Ministry of Health.
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In his letter to the Authority regarding immunisation in childhood, the Ministry of Health Chief Medical Officer referred to the conclusion of the Joint Committee on Vaccination and Immunisation in 1966 that the injection of killed measles vaccine followed four weeks later by an injection of live measles vaccine, or one injection of live measles vaccine given alone, were effective and acceptable immunising procedures, and said that the Joint Committe, after studying further results of the Medical Research Council's trials of measles vaccines, now took the view that immunisation against measles was best effected by means of one dose of live, attenuated measles virus vaccine alone. The Committee was also of the opinion that measles vaccine should be given in the second year of life after the basic course of immunisation against Diphtheria, Tetanus, Whooping Cough and Poliomyelitis.
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The appropriate statistical tables are shown hereunder: Immunisation of Persons under the age of 16 completed during 1967 Table 1 β€” Completed Primary Courses Type of vaccine or dose Year ol Birth Others under age 16 TOTAL 1967 1966 1965 1964 1960-3 1. Quadruple DTPP 1 14 41 10 17 - 83 2. Triple DTP 1288 1707 248 47 63 11 3364 3. Diphtheria/Pertussis 2 1 _ 1 β€” 4 4. Diphtheria/Tetanus 126 288 47 17 74 93 645 5. Diphtheria _ _ 1 β€” 1 6. Pertussis β€” 2 _ _ 2 7. Tetanus β€” β€” 2 _ 25 438 465 8.
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Salk β€” 10 15 15 20 3 63 9. Sabin 1254 2084 348 104 212 91 4093 10. Total immunised against Diphtheria (Lines 1-2-3-4-5) 1415 2011 337 74 156 104 4097 11. Total immunised against Whooping Cough/Pertussis (Lines 1-2-3-6) 1289 1725 290 57 81 11 3453 12. Total immunised against Tetanus (Lines 1-2-4-7) 1415 2009 338 74 179 542 4557 13.
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Total immunised against Polio (Lines 1-8-9) 1255 2108 404 129 249 94 4239 113 Table 2 β€” Re-inforcing Doses Type of vaccine or dose Year of Birth Others under age 16 TOTAL 1967 1966 1965 1964 1960-63 1. Quadruple DTPP 1 45 8 54 2. Triple DTP β€” 713 1448 145 527 145 2978 3. Diphtheria/Pertussis β€” β€” β€” 2 18 10 30 4. Diphtheria/Tetanus β€” Ill 238 63 1945 960 3317 5. Diphtheria β€” 1 1 β€” 23 282 307 6. Pertussis β€” β€” β€” β€” _ β€” 7.
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Tetanus β€” 1 3 2 27 285 318 8. Salk β€” 2 7 6 46 16 77 9. Sabin - 677 984 110 2389 1151 5311 10. Total immunised against Diphtheria (Lines 1-2-3-4-5) - 825 1688 210 2558 1405 6686 11. Total immunised against Whooping Cough/Pertussis (Lines 1-2-3-6) - 713 1449 147 590 163 3062 12. Total immunised against Tetanus (Lines 1-2-4-7) 825 1690 210 2544 1398 6667 13.
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Total immunised against Polio (Lines 1-8-9) - 679 992 116 2480 1175 5442 B.C.G. Vaccination against Tuberculosis Contacts of tuberculosis were vaccinated at Chest Clinics in the Borough, and school children aged thirteen and over and students were vaccinated at school and at establishments for further education by the Department's medical staff. After consultations between the Principal Medical Officer, School Health, and one of the Chest Physicians it was agreed that the method of testing children prior to B.C.G. vaccination, which had been continued from the days of the Medical Research Council's Field Trials, should now be changed to that of the multiple puncture technique. This would appear to have certain advantages over the previous intracutaneous method, not least of which are its simple efficient and reliable operation coupled with its use by a trained nurse thus saving Medical Officer's time. Tuberculin Test and B.C.G. Vaccination No.
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of persons vaccinated through the Authority's approved arrangements under Section 28 of the National Health Service Act. A. CONTACTS (i) No. skin tested 217 (ii) No. found positive 51 (iii) No. found negative 166 (iv) No. vaccinated 111 B. SCHOOL CHILDREN AND STUDENTS (i) No skin tested 3148 (ii) No. found positive 317 (iii) No. found negative 2645 (iv) No. vaccinated 2603 114 Whooping Cough Vaccination The investigation by the Public Health Laboratory Service of the sero-types currently responsible for cases of Whooping Cough proceeded in 1967, and the Authority continued to co-operate. Smallpox Vaccination There were no reports of cases of generalised vaccinia or post-vaccinal encephalomyelitis or death from any other complication of vaccination.