Showing posts with label local government. Show all posts
Showing posts with label local government. Show all posts

Wednesday, 4 May 2016

Local Health Authority Day Nurseries by Angela Davis

Local health authority day nurseries in post-1945 England 


In this month's blog Dr Angela Davis (University of Warwick) considers the fate of local health authority day nurseries in England from 1945 to the 1970s. While the national trajectory during this period may have been one of decline, this trend masks considerable local variation with some authorities regarding the day nursery as an intrinsic part of the health service and others considering them, at best, marginal.


War Nurseries


Handing over the Women's Voluntary Service War Nursery,
Manor House, Wendover, Buckinghamshire, England, UK,
1941, © IWM (D 2424).
In a Ministry of Health Circular in 1945 the Minister of Health for England and Wales declared that the right policy to pursue would be to positively discourage mothers of young children under two from going out to work and to make provision for children between two and five by way of Nursery Schools and Nursery classes.

From the numerous and widely used local authority administered day nurseries, commonly known as ‘war nurseries’, which were open to all working mothers during World War Two (in 1944 there were around 1,450 full-time nurseries and 109 part-time nurseries), in the late 1970s the day nursery service had become a much more limited form of provision intended to prevent children being harmed by inadequate homes or parents and to avoid the last resort of resort of residential care, including children from difficult family backgrounds, one-parent households, and some handicapped children.

Local Variation


However these national trends figures mask the very real variation at the local level that took place. State-provided day nurseries remained the responsibility of Ministry of Health in the years after the war (responsibility was finally transferred to the Social Services Departments in 1971), and administered through the local health authorities. The local health authority day nurseries were under the ultimate control of the medical officer of health for the area and these medical Officers of Health had very different attitudes about the importance of the provision of day nurseries. While some thought the service was an intrinsic part of the health and welfare provision in their area others were keen to cease providing the service altogether. Throughout the period the provision offered by London Local Authorities was higher than anywhere else in the country. In contrast, the provision offered in rural areas was the most limited. In order to consider these local differences more fully, will look at three case studies – Coventry, Camden (London) and Oxfordshire.

London Borough of Camden


The London Borough of Camden was created in 1965 from the former area of the metropolitan boroughs of Hampstead, Holborn, and St Pancras, which had formed part of the County of London. In 1948 there were 23 day nurseries in the health division area 2, which most closely resembled the later borough of Camden. These nurseries had places for 1,398 children. The divisional health officer explained that many of the wartime nurseries that had been requisitioned for the duration of the war had since been returned to their original uses. As a result, the number of children on the waiting list, which numbered 3,121, far exceeded the number of places available and therefore a scheme of priorities for admissions to day nurseries has been drawn up to take into account of economic and health factors. The cost to parents at this time was negligible. A standard charge of 1s. a day was made for each child placed which covered the cost of the midday meal. However, even the following year, the tone of the reports was changing with the London County Council Medical Officer now stressing that the high cost of maintaining a child in a day nursery caused concern, and attempts were being made to effect economies. Instructions were issued as to economical ordering of supplies and preparation of meals. By 1951 it had become policy that the total day nursery provision should be kept at its existing level, although notably no expansion was planned. Moreover attendances at the nurseries were to be continually under review and closures and amalgamations were to take place when possible. The ratio of staff to children reduced. Nurseries were now to be closed on Saturdays and the priorities for admission were tightened.

Policy Reversal


Annual Report of the Medical Officer of Health
and Principal School Medical Officer for the
year 1965 by Wilfrid G. Harding (1966). Wellcome
Library, London's Pulse: Medical Officer of Health
Reports 1848-1972.
Interestingly, in 1953 there seemed to be a reversal in policy. The priorities for admission were softened. A third group was introduced, namely the children of working mothers whereby the parents income exceeded 9 pounds a week. Why did this occur? It seems clear that the council were concerned about falling attendances that had resulted from a central government order increase the charges for day nurseries with the charges for children at the nurseries was raised to a minimum of 4s. a day. As demand grew in the years that followed, however, the number of children admitted from priority group 3 was again reduced. Other groups were also seen as more needy, particularly those from ethnic minority backgrounds, but also children with disabilities. However there was no growth in the number of day nurseries to match the increased demand. In 1965, the report of the new Camden health authority, reported that the council had ten nurseries providing 541 places for children under five. This compared to the 23 nurseries with places for 1,398 that had existed in 1948.



Cutting Costs


So what do these reports from Camden reveal? Firstly, they indicate that provision declined rapidly after World War Two, but mainly from a desire to cut costs. Nowhere is it mentioned that the policy of the council was that the place of young children was to be with their mothers. The priorities for admission reflected this overriding economic concern. Priorities were tightened when the nurseries were over-subscribed and reduced when attendances fell. The authority seemed to be guided above all by a desire for the day nurseries to be cost effective and seemed to view them a worrying expense rather than an essential part of their service.

Coventry


Portrait of Sir A. Massey.
Wellcome Library, London.
But not all authorities viewed day nurseries in the same way. In his Annual Report from 1944 Arthur Massey, the Coventry Medical Officer of Health stated that, ‘There is no doubt that there is a useful place in the peace-time maternity and child welfare scheme for day nurseries, for they offer valuable medical, nursing and educational care to the children in attendance. Moreover they could provide for the occasional care of children of mothers needing respite from the continual round of domestic work’ (p. 7).

It is clear from the outset that Coventry envisaged a wider for their day nurseries than the belief of central government that they should only be for children in ‘special need’. In consequence every effort was made to keep the nine day nurseries that had existed during the war in operation in the years that followed.

Reducing Charges


Coventry health authority also reacted in a very different way to London in response to Ministry of Health Circular No. 23/52 which increased the daily charges of the nurseries. Like London, Coventry quickly saw a fall in numbers, but unlike London, who responded by opening up the nurseries to non-priority groups, Coventry responded by reducing the charges. Moreover, rather than aiming to simply maintain provision at the level of the early 1950s as London did, Coventry wanted to increase day nursery provision. They were certainly not seeking to reduce their number of nurseries. Indeed the poor state of the current nurseries, the need to build new nurseries, and the increasing demand upon places was a constant refrain in the annual reports. By the mid-1960s, the medical officer reported that they could no longer offer places even to those deemed of high priority. Moreover in his report from 1969 the then Medical Officer of Health Thomas Clayton clearly indicated that he would like to reduce the stringency of the priorities imposed, stating: ‘The slowly declining birth rate has as yet had little effect on the under 5 population and the static day nursery provision is gradually becoming more inadequate. (p. 38). Moreover, unlike in Camden, the Medical Officer could report in 1970 that the number of day nurseries in Coventry had remained at the same level as at the end of the war. In 1948 there were 9 nurseries with 88,650 attendances. In 1970 there were still nine nurseries with 89,437 attendances.

An Essential Part of Health Authority Provision


So from the Coventry experience we can see that some local health authorities took a far more active approach to the provision of day nursery provision than my other case studies. The Coventry Medical Officer of Health saw day nurseries as an essential part of health authority provision in the area. Rather than seeking to reduce the service or being concerned about the cost of providing day nurseries, he was constantly wanting to expand the number of nurseries and places he could offer, and indeed make them available to children without ‘special needs’. Moreover, he was clearly frustrated with the lack of encouragement he received in this ambition from central government.

Oxfordshire


A Nursery School: Watlington Park Children
in Wartime - Five Lithographs by Ethel Gabain.
© IWM (Art.IWM ART LD 263).
The provision of day nurseries in Oxfordshire was considerably lower than in either Camden or Coventry. From the seven war nurseries that had been open throughout the county in 1945, only 2 remained in 1948, accommodating about 80 children.

The Medical Officer noted that they were ‘primarily intended for mothers who are forced by economic circumstances to go out to work. By 1951, there was only one day nursery provided by the county, in Banbury, accommodating 40 children. In 1960 the Medical Officer of Health was questioning the nursery’s continued existence. While the nursery did stay open, it was clearly not viewed as an essential service.

Better off at Home with Mother


The reason for this ambivalence may be in the Oxfordshire local health authority’s attitude towards the institutional care of children. They clearly felt that young children were better off with their mothers and in his 1966 report stated: ‘attendances under the age of two and a half are discouraged’ (pp. 18-19). However, the annual reports also documented the growing demand for day nursery care in Oxfordshire, which the Medical Officer of Health attributed to the increasing urbanisation of Oxfordshire. However, even in 1970, there remained only one nursery in the County. So it is clear that day nursery provision was considered as being rather marginal to the Oxfordshire local health authority. They were unsure about whether they should provide such a service and indeed whether young children should be in day nurseries at all.

Variable Provision


The provision local health authority day nurseries in postwar England was highly variable. It depended on the different material conditions and make-up of the populations in different areas, but also upon on local policies and personalities. For example the Medical Officer in Coventry championed day nurseries in a way that was not seen in Camden and which may account for the continued level of nursery places throughout the decades after the wars.

Angela Davis

Dr Angela Davis, Centre for the
History of Medicine, School of
History, University of Warwick.

Angela Davis is a Senior Research Fellow (Wellcome University Award) in the Department of History at the University of Warwick. Her research interests concern parenthood and childcare in Britain and Israel and the use oral history. Her book Pre-school Childcare, 1939-2010: Theory Practice and Experience was published with Manchester University Press in 2015.

You can listen to a podcast below of a talk by Angela, 'Developing Bodies and Minds: Children's Experiences of Preschool Childcare, Britain c.1939-1979',  given as part of the CHOMI Seminar Series, 29 January 2015.



Monday, 22 February 2016

Parochial Officers of Health in pre-Famine Dublin by Ciarán McCabe

In this month's blog Dr Ciaran McCabe, an Irish Research Council funded postdoctoral fellow  (NUI Galway), considers the oft-neglected figure of the parochial health officer and his role in the prevention of contagion and fighting fever epidemics in early nineteenth-century Ireland. In 2011, Dr McCabe successfully completed a MA thesis at the Centre for the History of Medicine in Ireland, UCD, on the impact of the 1817-19 and 1826-27 fever epidemics on the Cork Street Fever Hospital, Dublin. 

Preventing the Danger of Contagion and Other Evils


The Fever Act of 1819 empowered parish 
vestries to elect unpaid officers of health
From the middle of the seventeenth century, civil parish vestries in Ireland carried out functions which we would today associate with local government services: fire-fighting, tree planting, public lighting, and the repair of roads. Parishes also undertook to provide some assistance to local parishioners in distress and this relief included the support of local 'foundlings', the purchase of coffins for local paupers, payments of cash to widows and the maintenance of an alms-house, typically inhabited by local widows. Parish vestries were of such importance as units of local government that it was upon them that powers were bestowed for the prevention of contagion in response to the 1817-19 fever epidemic. The 1819 Fever Act empowered parish vestries to elect unpaid officers of health, who had the authority to direct that tenements, lanes and streets be cleaned, and that nuisances be removed from the streets. These officers also had the power to apprehend and dismiss from the parish 'all idle poor Persons, Men, Women, or Children, and all Persons who may be found begging or seeking Relief' in the interest of 'preventing the Danger of Contagion and other Evils'.1

Officers of Health: Respectable Parishioners


The positions of officers of health were filled by respectable parishioners, who also typically served as churchwardens, sidesmen and overseers. To these men (and they were invariably men), such voluntary service gave them an opportunity to display their civil responsibilities, as well as asserting their prominence within the community. Toby Barnard has argued that 'as in England, so in Protestant Ireland, a willingness regularly to assume the burdens of parochial office may have helped the middling sort to define and so distinguish themselves from the lower ranks'.2 Among the officers of health in St Michan's parish in the 1830s were Mark Flower of Old Church Street and merchant William Hill of 47 Pill Lane, who also served together as sidesmen and overseers of licenced houses.3 In some instances, parishioners who were qualified medical practitioners  were elected to serve as officers of health, such as David Brereton MD in St Michan's in 1831.4 In St Thomas's parish in 1828, four of the ten elected officers of health were medical practitioners.5

The Fever Act (1819)


A notice issued by the officers of
health in St Werburgh parish,
November 1831
The Fever Act was passed in June 1819, by which point the nationwide fever epidemic had petered out. With the emergency over, parishes were slow to fill the positions of officers of health, which, while not encompassing any salary, required the levying of a parish cess to cover expenses. Shortly after the legislation was passed, the Head of Police wrote to each of the Dublin parishes, reminding them of of their duties to elect officers under the new Fever Act.6 In St Catherine's the first officers of health were appointed two months after the legislation was passed while it took nine months for the first officers to be appointed in St Werburgh's parish.7 Such delays could be criticised, yet on the other hand, given that the worst of the epidemic had passed, parishes were understandably reluctant to assume additional expenditure on unnecessary undertakings.



Cholera Epidemic


Freeman’s Journal, 17 November 1831. The parish vestry 
of St Anne’s in Dublin city appointed officers of health in 
late-1831, following reports that cholera had reached
 England and was believed likely to spread to Ireland
For the first decade after the enactment of the 1819 fever legislation, many parishes avoided filling these positions. Parish expenditure had to be raised through the taxation of local parishioners, who, in some cases in Dublin city, paid up to sixteen different taxes to various local authorities.8 The significance of the 1819 Fever Act, empowering parish vestries to spearhead the local responses to epidemic disease, was not realised until more than a decade after its enactment, when cholera made its first appearance in western Europe. In late-1831, when reports reached Ireland that cholera had been identified in England, parish vestries throughout the country held emergency meetings, drawing on their powers under the 1819 act and rapidly appointing officers of health as a measure to prevent – albeit unsuccessfully – the introduction and propagation of cholera.

To Guard Against Contagion


In St Andrew's parish in December 1831, a cess was levied on parishioners to enable the work of the officers of health by means of 'cleansing & whitewashing the dwellings of the poor in order to guard against contagion'.9 Two weeks earlier in St Catherine's parish, the sum of £50 was levied on parishioners following reports 'that a pestilential has raged in several parts of Europe form sometime under the name of Cholera Morbus, which it is feared may shortly extend its ravages to this Kingdom'.10 Cholera eventually reached Ireland in the spring of 1832 and throughout the epidemic, parochial officers of health carried out measures to mitigate the impact of the contagion. A question which remains unanswered is how the parochial officers of health interacted with other authorities, such as the state-run Board of Health. The rejection in October 1832 by officers of St James's parish of the Board of Health's right to interfere in parochial matters suggests the existence of inherent tensions between these parties, yet the extent to which this single instance is representative of a wider trend is as of yet unclear.11

A dead cholera victim in Sunderland, 1832. Following the outbreak of cholera in north-east
England, Irish parish vestries rushed to appoint officers of health. Wellcome Images


The Decline of the Parochial Officer of Health


Some parishes continued to appoint officers of health throughout the 1830s but the practice declined by the 1840s; yet there are some instances of officers being appointed by parishes in Ulster into the 1850s.12 The power of parish vestries to appoint officers of health was repealed by the 1866 Sanitary Act,13 which extended earlier legislation for England to Ireland and was passed at the height of yet another cholera epidemic. Responsibility for sanitary regulations was transferred to a new Public Health Committee, which operated under the auspices of Dublin Corporation.14 As well as reflecting wider developments in public health reform in this period, the decline of the parochial officer of health was also a symptom of the gradual removal of civil functions from Irish parish vestries. Although constituting relatively short-lived positions with limited powers, and whose efficacy in mitigating the impact of contagion is difficult to gauge, parochial officers of health remain an interesting and neglected part of the social and medical landscape of nineteenth-century Ireland.

Dr Ciarán McCabe


Dr Ciarán McCabe is an Irish Research Council Government of Ireland postdoctoral fellow at the Moore Institute, NUI Galway. In 2015 he was awarded a PhD by Maynooth University for his thesis which examined begging and alms-giving in pre-Famine Ireland. He is currently writing a monograph arising from his doctoral research. Dr McCabe holds a Masters in the Social and Cultural History of Medicine from the Centre for the History of Medicine in Ireland (CHOMI), UCD and also serves as compiler for Irish History Online.




1 An act to establish Regulations for preventing Contagious Diseases in Ireland', 59 Geo. III, c. 41 (14 June 1819).
2 Toby Barnard, A New Anatomy of Ireland: The Irish Protestants, 1649-1770 (New Haven and London), 2003), p. 242.
3 St Michan's parish, Dublin, vestry minute book, 7 April 1828 (Representative Church Body Library (RCBL), St Michan's parish, Dublin, vestry minute books, P 276.05.5; ibid., 23 December 1828; ibid., 9 April 1832; 20 April 1835. Hill also served as churchwarden: ibid., 4 April 1836.
4 St Michan's parish, Dublin, vestry minute book, 23 November 1831.
5 St Thomas parish, Dublin, vestry minute book, 7 April 1828 (RCBL, St Thomas's parish, Dublin, vestry minute books, P 80.5.2).
6 Saunder's Newsletter, 19 August 1819.
7 St Catherine's parish, Dublin, vestry minutes, 24 August 1819 (RCBL, St Catherine's parish, Dublin, vestry minute books, P 117.05.7); St Werburgh's parish, Dublin, vestry minutes, 25 March 1820 (RCBL, St Werburgh's parish, Dublin, vestry minute books, P 326.05.2).
8 Jacinta Prunty, Dublin Slums, 1800-1925: A Study in Urban Geography (Dublin, 1998), p. 67.
9 St Andrew's parish, Dublin, vestry minutes, 12 December 1831 (RCBL, St Andrew's parish, Dublin vestry minute books, P 059.05.2).
10 St Catherine's parish, Dublin, vestry minutes, 28 November 1831.
11 The Pilot, 12 October 1832.
12 Belfast Newsletter, 28 August 1851, 14 April 1852, 3 May 1854.
13 'An act to amend the Law relating to Public Health', 29 & 30 Vict., c. 90, s. 69 (7 August 1866).
14 Prunty, Dublin Slums, pp 70-71.