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The group care of young children outside the home
1I6
PUBLIC HEALTH, July, 1945
supply in all rural areas ; drainage may present local difficulties and electric lighting m a y not have reached every part of the country, but a new Manual would assist in setting up a standard and it should be a uniform standard. (4) Would it be well for the Ministry to revise and re-issue the definition of a fit house given in the Manual of Unfit Houses of 1919 ? It is desirable that the Ministry of Health itself should give such further guidance and this m i g h t well be done by the revision and re-issue of those portions of the housing manuals of 1919 and 1938 which laid down standards of fitness fo~ houses. (It is believed that it would be an advantage to sanitary inspectors and medical officers if a section could be added to this manual giving details of the m o r e important legal decisions relating to the repair or condemnation of unfit houses. T h e suggestion is also m a d e that a copy of the n e w m o d e l by-laws, Series 4, should be included in the revised manual w h e n it is re-issued.) (5) If so, in what respects does this definition require revision in the light of present circumstances ? As explained above, it is considered desirable that revised standards should be issued now for application in two stages. Minimum requirements of a fit house.--This should be the subject of immediate enforcement. A f i t house should be (1) free from d a m p n e s s ; (2) properly v e n t i l a t e d ; (3) properly drained and provided with adequate sanitary conveniences and a sink, and suitable arrangements for disposing of slop w a t e r ; and (4) in sound structural condition and in good general r e p a i r ; and should have (5) a satisfactory internal water supply ; (6) adequate natural lighting, including the lighting of passages and staircases ; (7) adequate accommodation for washing c l o t h i n g ; (8) adequate facilities for preparing and cooking f o o d ; (9) a separate well-ventilated food s t o r e ; (10) provision for the storage of house refuse and fuel ; (11) adequate f~cilities for personal ablutions. Other Standards.--In addition to the above the following standards should be laid, down now, b u t their enforcement should be postponed for a period of ten years : - (1) W'here there is an adequate piped or private supply of water and sewerage or adequate private sewerage provided, a bath and separate b a t h r o o m be required, together with a domestic hot-water system, an internal water closet and, convenient to this, a fixed wash basin. (2) E v e r y house should have a separate wash-house or scullery. (3) A d e q u a t e cupboard accommodation should be provided for utensils, clothing, etc. (4) I n addition to heating arrangements in the living r o o m and kitchen, at least one b e d r o o m should be provided with a fireplace. (5) W h e r e practicable, secondary means of access should be provided. (6) W h e r e practicable, that separate access to each b e d r o o m be required. (7) W h e r e electricity or gas is available, that one such form of artificial lighting be required , to be laid on to every habitable room.
Definition of " Dwelling Home " (6) Is there any other form of guidance which should be given? T h i s question is largely covered by the replies given above, b u t it is desired to call attention to a serious p r o b l e m which exists in m a n y large towns. In L o n d o n and other cities there are large n u m b e r s of big houses which have descended in the social scale and are now let off in floors or sections to workingclass families. T h e s e apartment houses are to some extent controlled by by-laws m a d e u n d e r Section 6 of the H o u s i n g Act, 1936, or previous enactments, b u t the control is not sufficiently strict and the p o w e r to make by-laws is not sufficiently wide. T h e definition of " dwelling house," given in Section 68 of the H o u s i n g Act, 1936, only applies to Part I V of that A c t and cannot be invoked for the enforcement of Section 9. T h e Ministry of Health can require a local authority to make by-laws u n d e r Section 9, and these m a y be limited
to houses let-in-lodgings, but the powers so given are restricted and do n o t go nearly far enough. It would be of t h e greatest assistance to local sanitary authorities if the definition of a house, as given in Section 68, could be applied to Part I of the said Act.
THE
G R O U P C A R E OF Y O U N G C H I L D R E N O U T S I D E T H E HOME [ The Royal Commission on Population, having invited the Society of Medical Officers of Health to submit a Memorandum from its Maternity and Child Welfare Group on the above subject, the President, on May 2end, 1946, submitted the Group's Memorandum as follows]. I n reply to the query by the Royal Commission on Population, as to what part day-nursery provision might play in the relief of strain for young mothers, we wish to say in the first instance that we agree that a w o m a n w i t h children u n d e r five years of age requires time for shopping, doing the washing and countless other tasks u n h a m p e r e d by the continuous demands of small children, and that she should have some time available to enjoy the companionship o f her husband. She should also have the opportunity, if she so desires, of making her contribution to the life of the c o m m u n i t y outside her own home. T h e claims of the child, however, should come first and the question m u s t be a s k e d : " Is the p r o vision of day-nursery accommodation, from the child's point of view, the best m e t h o d of relieving strain on the m o t h e r " ? T h e answer to this is to some extent dependent on the age of the child and on the a m o u n t and quality of any domestic help which m a y be available. Children u n d e r the age of t h r e e years, whose mothers do not go out to work, should be cared for in their own homes. I f the m o t h e r requires assistance to relieve her from the strain of her domestic duties, then this is best provided by a good h o m e help. I f such a h o m e help is not available, then the placing of the child for short periods in a nursery can be considered only as second best to a good home. It should be emphasised that there are dangers in congregating large numbers of small c h i l d r e n together either in nurseries or in nursery schools, although we recognise these dangers can be minimised by good and well-equipped premises, with staff-medical, nursing and educational--adequate in n u m b e r s and efficiency. F o r children over the age of three the solution would appear to be the nursery school, in suitable premises and with good equipment. T h e staff m u s t be adequate and well trained, especially in the taws of hygiene and prevention of the spread of infection. A period of years is likely to elapse, however, before there can be full nursery-school provision for all children between the ages of three and five. Moreover, nursery school teachers prefer that their children should be in regular daily a t t e n d a n c e ; they do not welcome a floating population. T h e s e two factors will limit for a time the n u m b e r of children w h o can be admitted to nursery schools. I n the ease of children in this age group for w h o m accommodation cannot be found in nursery schools part-time day-nursery provision serves a useful purpose. I n our view, extensive provision of day-nursery accommodation for the children whose mothers do not go out to work should not be embarked on to the exclusion of efforts to obtain a sufficient supply of efficient h o m e helps. T h e limited provision of part-tlme day nurseries, provided they were adequately housed, staffed and equipped, w o u l d make a cd~tribution to the relief of stralh on the mother. W e would emphasise that the mere change of name from nursery school to day nursery does not make the provision of suitable premises, adequate e q u i p m e n t and efficient staff any less important. Finally, we w o u l d add that it is possible that in the future crbches and day nurseries m a y be provided by private firms for use either by their customers or by their employees. I f so, then they should be registered with, and inspected by, the local authority, and should be required to conform with certain reeognised standards of premises, staffing and equipment.
PUBLIC HEALTH, July, 1945
supply in all rural areas ; drainage may present local difficulties and electric lighting m a y not have reached every part of the country, but a new Manual would assist in setting up a standard and it should be a uniform standard. (4) Would it be well for the Ministry to revise and re-issue the definition of a fit house given in the Manual of Unfit Houses of 1919 ? It is desirable that the Ministry of Health itself should give such further guidance and this m i g h t well be done by the revision and re-issue of those portions of the housing manuals of 1919 and 1938 which laid down standards of fitness fo~ houses. (It is believed that it would be an advantage to sanitary inspectors and medical officers if a section could be added to this manual giving details of the m o r e important legal decisions relating to the repair or condemnation of unfit houses. T h e suggestion is also m a d e that a copy of the n e w m o d e l by-laws, Series 4, should be included in the revised manual w h e n it is re-issued.) (5) If so, in what respects does this definition require revision in the light of present circumstances ? As explained above, it is considered desirable that revised standards should be issued now for application in two stages. Minimum requirements of a fit house.--This should be the subject of immediate enforcement. A f i t house should be (1) free from d a m p n e s s ; (2) properly v e n t i l a t e d ; (3) properly drained and provided with adequate sanitary conveniences and a sink, and suitable arrangements for disposing of slop w a t e r ; and (4) in sound structural condition and in good general r e p a i r ; and should have (5) a satisfactory internal water supply ; (6) adequate natural lighting, including the lighting of passages and staircases ; (7) adequate accommodation for washing c l o t h i n g ; (8) adequate facilities for preparing and cooking f o o d ; (9) a separate well-ventilated food s t o r e ; (10) provision for the storage of house refuse and fuel ; (11) adequate f~cilities for personal ablutions. Other Standards.--In addition to the above the following standards should be laid, down now, b u t their enforcement should be postponed for a period of ten years : - (1) W'here there is an adequate piped or private supply of water and sewerage or adequate private sewerage provided, a bath and separate b a t h r o o m be required, together with a domestic hot-water system, an internal water closet and, convenient to this, a fixed wash basin. (2) E v e r y house should have a separate wash-house or scullery. (3) A d e q u a t e cupboard accommodation should be provided for utensils, clothing, etc. (4) I n addition to heating arrangements in the living r o o m and kitchen, at least one b e d r o o m should be provided with a fireplace. (5) W h e r e practicable, secondary means of access should be provided. (6) W h e r e practicable, that separate access to each b e d r o o m be required. (7) W h e r e electricity or gas is available, that one such form of artificial lighting be required , to be laid on to every habitable room.
Definition of " Dwelling Home " (6) Is there any other form of guidance which should be given? T h i s question is largely covered by the replies given above, b u t it is desired to call attention to a serious p r o b l e m which exists in m a n y large towns. In L o n d o n and other cities there are large n u m b e r s of big houses which have descended in the social scale and are now let off in floors or sections to workingclass families. T h e s e apartment houses are to some extent controlled by by-laws m a d e u n d e r Section 6 of the H o u s i n g Act, 1936, or previous enactments, b u t the control is not sufficiently strict and the p o w e r to make by-laws is not sufficiently wide. T h e definition of " dwelling house," given in Section 68 of the H o u s i n g Act, 1936, only applies to Part I V of that A c t and cannot be invoked for the enforcement of Section 9. T h e Ministry of Health can require a local authority to make by-laws u n d e r Section 9, and these m a y be limited
to houses let-in-lodgings, but the powers so given are restricted and do n o t go nearly far enough. It would be of t h e greatest assistance to local sanitary authorities if the definition of a house, as given in Section 68, could be applied to Part I of the said Act.
THE
G R O U P C A R E OF Y O U N G C H I L D R E N O U T S I D E T H E HOME [ The Royal Commission on Population, having invited the Society of Medical Officers of Health to submit a Memorandum from its Maternity and Child Welfare Group on the above subject, the President, on May 2end, 1946, submitted the Group's Memorandum as follows]. I n reply to the query by the Royal Commission on Population, as to what part day-nursery provision might play in the relief of strain for young mothers, we wish to say in the first instance that we agree that a w o m a n w i t h children u n d e r five years of age requires time for shopping, doing the washing and countless other tasks u n h a m p e r e d by the continuous demands of small children, and that she should have some time available to enjoy the companionship o f her husband. She should also have the opportunity, if she so desires, of making her contribution to the life of the c o m m u n i t y outside her own home. T h e claims of the child, however, should come first and the question m u s t be a s k e d : " Is the p r o vision of day-nursery accommodation, from the child's point of view, the best m e t h o d of relieving strain on the m o t h e r " ? T h e answer to this is to some extent dependent on the age of the child and on the a m o u n t and quality of any domestic help which m a y be available. Children u n d e r the age of t h r e e years, whose mothers do not go out to work, should be cared for in their own homes. I f the m o t h e r requires assistance to relieve her from the strain of her domestic duties, then this is best provided by a good h o m e help. I f such a h o m e help is not available, then the placing of the child for short periods in a nursery can be considered only as second best to a good home. It should be emphasised that there are dangers in congregating large numbers of small c h i l d r e n together either in nurseries or in nursery schools, although we recognise these dangers can be minimised by good and well-equipped premises, with staff-medical, nursing and educational--adequate in n u m b e r s and efficiency. F o r children over the age of three the solution would appear to be the nursery school, in suitable premises and with good equipment. T h e staff m u s t be adequate and well trained, especially in the taws of hygiene and prevention of the spread of infection. A period of years is likely to elapse, however, before there can be full nursery-school provision for all children between the ages of three and five. Moreover, nursery school teachers prefer that their children should be in regular daily a t t e n d a n c e ; they do not welcome a floating population. T h e s e two factors will limit for a time the n u m b e r of children w h o can be admitted to nursery schools. I n the ease of children in this age group for w h o m accommodation cannot be found in nursery schools part-time day-nursery provision serves a useful purpose. I n our view, extensive provision of day-nursery accommodation for the children whose mothers do not go out to work should not be embarked on to the exclusion of efforts to obtain a sufficient supply of efficient h o m e helps. T h e limited provision of part-tlme day nurseries, provided they were adequately housed, staffed and equipped, w o u l d make a cd~tribution to the relief of stralh on the mother. W e would emphasise that the mere change of name from nursery school to day nursery does not make the provision of suitable premises, adequate e q u i p m e n t and efficient staff any less important. Finally, we w o u l d add that it is possible that in the future crbches and day nurseries m a y be provided by private firms for use either by their customers or by their employees. I f so, then they should be registered with, and inspected by, the local authority, and should be required to conform with certain reeognised standards of premises, staffing and equipment.