View report page

61
CHAPTER XXV.
Public Health.
The responsibility in London for the public provision of treatment for tuberculosis rests on the
Council, which in 1914 prepared a comprehensive scheme. Under this scheme the Council provides or
arranges for the provision of residential treatment required through a public authority (other than
poor law guardians), and the metropolitan borough councils provide or arrange for the provision of
dispensary treatment.
Treatment
of tuberculosis—
History
Arrangements for the residential treatment of uninsured adults and children have been undertaken
by the Council since 1914, and in 1920 the Council commenced to make arrangements for the
provision of residential treatment of insured persons and discharged soldiers and sailors. The National
Health Insurance Act, 1920, provided for the discontinuance of sanatorium benefit, and by the combined
operation of this Act and the Public Health (Tuberculosis) Act, 1921, the responsibility for the institutional
treatment of tuberculous insured persons was transferred, as from 1st May, 1921, from the
Insurance Committees to the local authorities responsible for the institutional treatment of the remainder
of the population.
Becoming thus responsible for the residential treatment of tuberculous persons in London, the
Council has been able to ensure that the best possible use is made of all existing accommodation. The
number of cases awaiting residential treatment has also been reduced to a minimum. In securing accommodation
it has been the policy of the Council to take advantage of all suitable accommodation already
provided by hospital and sanatorium authorities, including the Metropolitan Asylums Board, the
authority for the residential treatment of infectious diseases in London, and to take advantage also of
such additional suitable accommodation as such authorities may provide by arrangement with the
Council.
Accommodation.
The Council s improved method of selecting cases for residential treatment depends on the
provision of observation beds. These have been reserved at the Brompton and the Victoria Park Chest
hospitals, which possess the best available facilities for highly skilled expert diagnosis.
Selection
cases for
treatment.
Certain kinds of accommodation to which patients are sent after observation are available only
in voluntary institutions ; for example there are certain voluntary institutions for patients who are
Roman Catholics, or members of the Jewish community. It is necessary also to provide for the treatment
of patients under certain climatic conditions, such as those at Ventnor and Bournemouth, and
voluntary institutions afford the only present means of taking full advantage of climatic conditions, and
of obtaining further knowledge of the influence of climate in the treatment. Great advantage is derived
from the use of sanatoria linked to hospitals as is the case with Frimley Sanatorium and Brompton
Hospital.
Arrangements are made with the seamen's Hospital lor the treatment of tuberculous seamen.
Special arrangements, apart from insurance committees, have obtained hitherto with regard to the
treatment for tuberculosis, under the National Health Insurance Acts, of masters, seamen, or apprentices
to the sea service or the sea-fishing service who were members of the Seamen's National Insurance
Society. As empowered by section 7 of the Public Health (Tuberculosis) Act, 1921, the Minister of
Health, on 30th September, 1921, made an Order constituting an advisory committee for the purpose
of assisting the county authorities in making arrangements for the treatment of all masters, seamen,
etc. The Council is empowered to appoint a representative on the advisory committee, and has
appointed the chairman of the Public Health Committee (Captain O. E. Warburg, O.B.E., M.A.).
Seamen.
Payments to the Council by H.M. Government towards the cost of residential treatment for
tuberculosis consist of (i) an annual grant payable from the Exchequer in consequence of the termination
of sanatorium benefit; (2) the actual cost of approved arrangements for the treatment of exService
men ; (3) a proportion of the moneys available to H.M. Government for distribution amongst
local authorities in respect of the treatment of seamen ; and, (4) a contribution of 50 per cent, of the
balance of the approved net expenditure of the Council on residential treatment after taking into account
the Government payments under (1) to (3) above.
Finance.
Under certain conditions the Council requires a contribution towards the cost or residential
treatment. In respect of both adults and children the amount is fixed in each case by the
local Tuberculosis Care Committee; their assessments are reviewed by the Public Health SubCommittee.
For children a small charge, roughly equivalent to the cost of maintaining a child at
home is made, and the sums so received are applied by the Council towards such objects as accessories
to treatment and after-care of child patients ; grants are also made to the Invalid Children's Aid Association.
For adults a charge is made if the patient or the person legally responsible has an income not less
than £160 a year, or if the patient, having no dependents is in receipt of an income less than £160 a
year, and the circumstances of the case appear to justify the demand. If a patient is an insured
person whose income is the main support of the family, or an ex-Service patient for whose treatment
the Ministry of Pensions is responsible, no assessment is made in respect of the cost of treatment. The
contributions received from adults are credited to the County Fund, but the proportion attributable to
residential treatment in institutions of the Metropolitan Asylums Board is paid to the Board.
Patients'
contributions.