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III.—Residential accommodation for adults.
Persons insured under the National Insurance Act, 1911.
8. (a) The Council has given its consent, under the National Insurance Act, 1913, to the London
Insurance Committee entering into an agreement with the Metropolitan Asylums Board for the provision
of accommodation for insured persons.
(b) The London Insurance Committee have made arrangements, under the Insurance Act, 1911,
with voluntary institutions for other accommodation for insured persons, and are empowered to secure
further such accommodation.
(c) Arrangements will be made by the Council, if desired by the London Insurance Committee,
for the provision of residential accommodation for the treatment of " insured " persons suffering from
tuberculosis, on the understanding that the whole of the cost of providing such accommodation
and treatment shall be defrayed out of insurance funds.
Uninsured persons.
9. Arrangements shall be made by the Council, with the approval of the Local Government
Board, for the provision of residential accommodation of the following kinds—(1) observation, (2) hospital,
(3) sanatorium, and (4) chronic or advanced cases. The amount of accomn odat'ontobe provided will be
determ'ned from t me to time by the Council. The Council in making such provision shall take advantage
of accommodation already provided by hospital and sanatorium authorities, ir eluding the Metropolitan
Asylums Board, or of such additional accommodation as such authorities are prepared to provide. In
determining the fresh provision to be made the Council will have regard to the exisling provision for
tuberculous persons in infirmaries. The Council, being of opinion that adequate accommodation will
thus be available, does not consider it necessary itself to purchase, erect or maintain institutions.
Selection of cases.
10. The medical officer of a dispensary, or the medical practit oner concerned, and the local medical
officer of health, when recommending an adult patient for residential treatment, shall state whether,
in their opinion, the patient cannot afford to pay for such treatment, or can afford to pay to a specified
extent, as the case may be. In the case of children requiring residential treatment, a report as to the
ability of the parent to pay for such treatment shall be obtained from the Education Committee.
11. A medical practitioner, when recommending for residential treatment a patient who is not
attending a dispensary, shall forward his recommendation to the local medical officer of health, who should
ordinarily refer the case to the dispensary.
12. For the purpose of selecting patients (uninsured) for residential treatment, the following
procedure shall be adopted—
(i) There shall be established an honorary advisory board consisting of—
(a) One representative appointed by each of the teaching and other general hospitals
and children's hospitals which are acting in any capacity under the scheme.
(b) Two representatives appointed by each of the three special chest hospitals.
§ (c) The medical superintendent appo nted by each of the sanatoria with which
arrangements have been made by the Council.
§ (d) Two representatives of the tuberculosis dispensaries.
§ (e) The medical officer and the deputy medical officer of health appointed by the
County Council.
(/) The board shall be empowered, with the consent of the Council, to co.opt persons
possessing special medical or surgical knowledge.
(ii.) The representatives appointed by the hospitals specified in sub.section (i.) shall be
physicians and assistant physicians actively engaged in hospital practice.
(iii.) The honorary advisory board shall be asked to prepare a memorandum as to the
types of cases suitable for the various forms of institutional treatment for circulation to the
medical officers and institutions dealing with the cases; to advise as to forms for medical
reports ; and generally as to all matters required to secure the necessary uniformity of procedure
or upon which the Council may desire to have their opinion. The advisory board shall appoint,
from their own body, or, if thought desirable, from outside, a rota of two or more physicians
to act as medical referees and to examine all cases referred to them by the medical officer
of the county in accordance with the conditions to be prepared by the advisory board and
approved by the Council. These physicians shall attend as required at a limited number
of convenient centres to be arranged, having regard to the residence of the patients, for the
purpose of examining such cases, advising the county medical officer, and recommending as
to the action to be taken with reference to the patients. The members of the rota appointed
upon the advice of the advisory board shall serve for a period of not less than six months or such
longer period as may be found expedient, and each physician while serving on the rota shall be
paid an honorarium of one guinea for each case.
(iv.) It shall be referred to the dispensary medical officer to classify the cases clinically
as suitable for (a) home treatment, (6) consultative reference to hospitals, (c) in.patient hospital
treatment, (d) sanatorium treatment.
These gentlemen will not be eligible to serve on the rota.