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arrangements should be made for referring any specially difficult
cases from a municipal or voluntary dispensary to some general
or special hospital. In particular, the Board would be glad to
learn what general rules the County Council would suggest should
be observed in the working of the various local dispensaries so that
the work performed by these institutions may properly form part
of the whole scheme for London.
Brief particulars of the Dispensary arrangements which have
already been approved are enclosed. The Board would have
wished to consult the London County Council before approving
any Dispensary arrangements, but in some cases the urgency of
the matter has prevented the Board from taking this course.
In the further development of the Dispensary schemes, the Board
propose to give the London County Council an opportunity of
making any observations which they may wish to make in regard
to any new proposals.
As regards residential accommodation, the Board consider
that upon the County Council should rest the responsibility of
securing that the necessary accommodation is available. Much
of this accommodation can no doubt be economically and efficiently
provided by the Metropolitan Asylums Board in pursuance of
agreement between the London County Council and that body.
It may also be possible that the County Council could arrange
with some of the great London hospitals to provide beds for
special cases.
So far as insured persons and their dependents are concerned,
agreements with the Metropolitan Asylums Board may be made
in pursuance of the provisions of Section 39 of the National
Insurance Act, 1913. As regards the rest of the community, the
Board are disposed to the view that arrangements with the
Metropolitan Asylums Board could also be made by the County
Council under the provision of Section 3 of the Public Health
(Prevention and Treatment of Disease) Act, 1913, and Section 80
of the Public Health (London) Act, 1891.
The accommodation to be provided is to serve both the
insured and the non-insured, and the London County Council
should consult with the London Insurance Committee as to the
arrangements which are required for insured persons, and as to
the payments which the London Insurance Committee will make
for the services provided for such persons.