London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1920

Annual report of the Council, 1920. Vol. III. Public Health

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iv
effects upon any known data for purposes of calculation even in those hospitals where treatment had
been available for some years before 1916. It was, therefore, decided to pay a lump sum to each hospital
undertaking the work as a grant in aid, and it was hoped that, after several years' experience, sufficient
data would be forthcoming to enable a more accurate system of payment to be drawn up.
With regard to the division of the cost amongst the local authorities participating in the scheme
with the London hospitals, it was agreed that the amount payable by each participating authority
should be based upon two factors, viz., (a) the estimated population of the area of the authority to be
served by the hospitals, and (b) the actual user as ascertained at the end of each year from the returns
of addresses of patients. In this connection, it may be noted that the population to be served was
estimated at 7,659,000. Other features of interest and importance in connection with the
arrangements were that the grants in aid to the hospitals were divided into payments in respect of (a)
the work of the treatment centre, including the supply of Salvarsan or its approved substitutes for
patients treated at the hospital clinic, and the pathological examination of specimens sent to the
laboratory from those patients, and (b) the pathological examination of specimens sent to the hospital
laboratory by medical practitioners in the areas of the local authorities participating in the scheme. This
division of payment was made necessary by the fact that certain of the participating authorities, notably
Kent, had already made provision for the examination of samples sent by medical practitioners in the
County of Kent, and it would have been difficult, if not indeed impracticable, to devise any other method
of payment for laboratory work undertaken at the hospitals except the one above described.
Finally, it should be noted that the Local Government Board undertook at the request of all the participating
authorities the duty of assessing and collecting the contributions due from each authority,
and distributing the grant in aid to each hospital included in the scheme on the following lines :—
(a) An instalment of 50 per cent, of the amount payable by each participating authority
shall be paid to the Local Government Board before 31st March, 1917.
(b) The amount payable under (a) by each participating authority shall bear the same
proportion to the total amount payable by all the participating authorities as the estimated
population of the area of the authority to be served by the hospitals bears to the total estimated
population to be served in the areas of all the authorities.
(c) The Local Government Board shall distribute the amounts payable to the hospitals,
and at the end of the year, shall determine the actual amount to be paid by each of the participating
authorities on the basis of user.

The amounts payable by the several local authorities for the year 1917 on the basis above referred to are indicated in the following table:—

Authority.Treatment at hospitals.Pathological examination of materials.
Population to be served.Contribution.Population to be served.Contribution.
London County Council4,500,000£4,500,000£
15,8643,686
Buckingham County Council200,000705200,000164
Essex County Council500,0001,763750,000614
Hertford County Council250,000881311,000255
Kent County Council200,000705Kent County Cou ncil will make its own arranements.
Middlesex County Council900,0003,173900,000737
Surrey County Council540,0001,904676,000554
Croydon Corporation140,000493170,000139
East Ham Corporation140,000493140,000114
West Ham Corporation289,0001,019289,000237
7,659,000£27,0007,936,000£6,500

In addition to the grants in aid made to the hospitals under their agreements for the diagnosis
and treatment of venereal diseases, etc., etc., the Council became responsible for the payment for
Salvarsan substitutes supplied to approved medical practitioners for private patients residing in the
County of London, and for patients in Poor Law institutions. Payments were made by separate
accounts to the hospitals for the supply of these drugs, including postage, the hospitals acting in fact
as distributing agencies on behalf of the Council for this purpose, and being, of course, recouped for
the whole of their expenses in this connection. The Council also made provision for the giving of
instructional lectures and for the preparation and publication of reliable information on questions
relating to venereal disease. For this purpose arrangements were entered into with the National Council
for Combating Venereal Disease. The general principle underlying this agreement was that the Council
would undertake the dissemination of information and instruction in the cases of bodies of an official
character, e.g., the Metropolitan Police, etc., whereas the National Council for Combating Venereal
Disease would by means of a grant in aid from the Council concentrate its energies upon bodies of an
unofficial character, e.g., factories, workshops, etc. These in broad outline were the features of the
venereal diseases scheme which received the approval of the Council and the Local Government Board
as well as the councils of the participating authorities, and which came into operation on January 1st,
1917. They may be shortly summarised thus:—
(1) Restriction of scheme to voluntary hospitals.