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57
On the l5th January, 1918, a further letter on the same subject was received
from the Clerk of the London Insurance Committee: —
" With reference to previous correspondence on the question of
supplying food to insured persons, I am directed to draw your attention
to the National Health Insurance Commissioners' letter of the 28th
September, 1912 (a copy of which was sent to you) from which you will
note that the Committee themselves have 110 power to supply beds, special
forms of food and other accessories of treatment direct to persons receiving
sanatorium benefit under the provisions of the National Insurance Act.
The Committee are, however, now advised that they may make arrangements
for the supply to insured persons receiving home treatment as their patients
of such special food or extra nourishment as may be recommended as part
of that treatment by the medical practitioner attending the case.
In these circumstances they propose for the present to accept liability
for reasonable expenditure incurred by medical practitioners who have
already undertaken domiciliary treatment of their patients in ordering
articles forming part of, or which are strictly ancillary to that treatment.
It must, however, be carefully borne in mind that 110 account for unreasonable
expenditure will be passed and that the Committee have no power toarrange
for the provision of ordinary food, etc., to necessitous insured
persons who are in an impecunious position. The Poor Law Authority
is charged with that power."
It will be remembered that there was 110 waiting period provided for
sanatorium benefit ; it took effect from the commencement of the Act, namely
the 15th July, 1912. From this date it was the practice of the London
Insurance Committee, in those cases which were recommended for domiciliary
treatment, to communicate with the Medical Officer of Health asking him to
arrange for such treatment, the result of which was to co-ordinate home
treatment with the Public Health Department, but since the middle of January,
1913, when the panel system came into operation, the Public Health Department
receives no information from the Insurance Committee of the cases which
are being treated at home, the patients being referred direct to their panel
doctors.
Local Control—Each applicant for sanatorium benefit is required to fill up a
form and to be examined by his panel doctor. In cases where the applicant is
an inmate of an institution, the form may be signed by the Medical Superintendent
of the institution concerned. The following note appears on the form: —
" No person is entitled to receive sanatorium benefit unless recommended
by the Insurance Committee. The Committee are not prepared to
accept liability for the maintenance of insured persons who enter
institutions without the previous sanction of the Committee. A person
applying for sanatorium benefit must produce his or her contribution
card and insurance book and such other evidence as may be required
by the Insurance Committee. Sanatorium benefit may, at the discretion
of the Committee, take the form of treatment in a sanatorium,
hospital, dispensary or the patient's home."