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The care committee give advice and assistance to the patient and other
members of the family with regard to the care of the family generally, in order
to permit patient to accept, with a contented mind, the residential treatment
advised.
In the cases of patients undergoing residential treatment (in hospital, sanatorium
or infirmary), the home is kept under such regular supervision as may appear
necessary in order to determine the success of any efforts that have been made
towards improvement and in order to be fully informed of any change of circumstances
and of any conditions that may influence a decision as to extension of treatment
or otherwise. Attention is paid while the patient is away to the suitability
of the arrangements for the reception of the patient on discharge, including the
removal of the home to a more suitable location, if necessary and practicable,
and the endeavour is made to secure suitable work for the patient, or if
necessary some modification of the conditions of his former employment. Knowledge
of conditions at home often enables a visitor to intervene and dissuade patients
from taking a premature discharge, or parents from removing their children from
institutions while under treatment.
In the case of children and adults who are approved by the County Council for
treatment in residential institutions under the Council's scheme, the care committee
undertakes the assessment and collection of contributions in accordance with the
arrangements specified by the Council, the amount of the assessment being subject
to approval by the public health committee of the Council.
Residential
treatment.
In the matter of residential accommodation the Council directed its efforts
towards meeting the known deficiency of beds and the increasing demand which was
expected to result from the activities of the dispensary service in the discovery of
cases in the early stages when the most satisfactory results are derived from
sanatorium treatment. The duty of providing for insured persons was the function
of the London Insurance Committee and they made direct arrangements with the
authorities of residential institutions, including the Metropolitan Asylums Board,
for the use of beds. The direct responsibility undertaken by the Council in the first
instance was, therefore, limited to uninsured adults and children. Although the
scheme did not exclude provision for the treatment of advanced cases, action was
deferred pending further investigation, having regard to the fact that a considerable
proportion of such cases were treated in poor law infirmaries.
From the first the Council sought and obtained the co-operation of the hospitals,
both general and special, and of the Metropolitan Asylums Board, although, during
the war, the assistance available at the hospitals was limited by the heavy demands
made upon accommodation and staff, in dealing with wounded soldiers and in
military service of the normal staffs. The Metropolitan Asylums Board immediately
adapted two of its institutions, viz., Downs Sanatorium, Surrey, (which was originally
a school for children suffering from ringworm, etc.), and part of the Northern Hospital.
Winchmore Hill, (a fever hospital) for sanatorium cases. The Board also arranged
for part of the accommodation for children at Queen Mary's Hospital, Carshalton,
to be allotted to the Council's cases.
It was difficult, in 1914, to estimate with any degree of confidence the requirements.
The accommodation authorised under the original scheme of May, 1914,
was 160 hospital beds and 240 sanatorium beds for adults and 150 beds for children
in voluntary institutions, together with 100 beds for adults and 100 beds for
children in Metropolitan Asylums Board institutions, on the understanding that
the beds would be required gradually, the maximum being reached by March, 1915.
The outbreak of the war prevented extensions involving building operations,
and it became necessary to limit the numbers to the accommodation already available,
viz., 100 beds provided by the Metropolitan Asylums Board and 100 beds in voluntary
institutions for uninsured adults, and 150 beds provided by the Metropolitan Asylums