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CHAPTER XXV.
Public Health.
Treatment
of tuberculosis—
History.
The responsibility in London for the public provision of treatment for tuberculosis
rests on the Council which in 1914 prepared a comprehensive scheme.
In October, 1922, the Council made a revised scheme*, codifying, or declaratory of,
the arrangements obtaining in London as a result of decisions of the Council and the
Government departments concerned during the past eight years. The scheme has
involved no change in the main purposes underlying the original scheme, but will
have a special value, for administrative purposes, as a means of defining the relations
between the various public authorities and voluntary agencies working for the common
purpose of combating tuberculosis. The scheme was approved by the Minister of
Health.
Under the 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.
Clause 40 specifies the working arrangements into which the Council is prepared
to enter with the authorities of other county areas with regard to certain cases in
which questions may arise as to the county authority which should be responsible
for the provision and continuance of any course of residential treatment. This
clause lays down the general rule that when treatment is found to be necessary
responsibility for treatment shall rest on the authority of the area in which the patient
ordinarily resides. The Minister of Health apprehended that under this rule cases
might arise in which it would be difficult to determine in what area a patient is ordinarily
resident, and at his suggestion the clause provides that in any such case the
authority in whose area the patient is living when application for treatment is made
should be responsible for the provision of residential treatment.
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.
Accommodation.
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. General information with regard to the Council's
action for the provision of accommodation is given in the last Annual Report (vol. III.,
p. 61).
The Council agreed with the Metropolitan Asylums Board that the block
grant due to the Council from H.M. Government in consequence of the termination
of sanatorium benefit is to be allocated between the Board and the Council on the
basis of the average numbers of beds respectively occupied during the year by insured
civilians in institutions of the Board and in other institutions.
Patients'
contributions.
Under certain conditions the Council requires a contribution towards the cost
of 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 Sub-Committee. 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.
* Scheme for the treatment of tuberculosis in London. No. 2183. Price 4d.