ABOUT HOSPITAL CONTROL

Dominion, Volume 15, Issue 149, 20 March 1922, Page 6

ABOUT HOSPITAL CONTROL

. INTERESTING OFFICIAL OPINION LOCAL BOARDS SUPPORTED \ • ■ STATE DEPARTMENTS AND BUSINESS EFFICIENCY Ought the public hospitals to be under national control? The “Journal of Health and Hospitals," issued by the New Zealand Publio Health Depart- ( mont, says It is extremely improbable that a change from local control to national control would be a success, and . that the organisation of the publio service In the Dominion does not make for business efficiency. The final number of the ’‘Journal of Health and Hospitals” has been issued. This monthly magazine, controlled by the Public Health Department, has been condemned to cease publication in the interests of economy. it feature of the final number is a lengthy article discussing the question of the nationalisation of hospitals. The writer, who apparently presents the official view of the department, declares that “it is a most debateable question whether State enterprise of an ordinary business nature is ever warranted.” “The question is whether the State could administer the publio hospitals more economically and efficiently than the focal bodies in the shape of district hospital boards, provided that the latter are subject to sufficient inspection and control by an expert and experienced central Department,” says the journal. “After full consideration We are forced to confess that it is extremely improbable that it could do so. The organisation of the civil service in Now Zealand, in common with that of roost other countries, is such that, though best suited for the general purpose of government, it is not the most suitable for business en--1 terprise. ' ■ Hampering Regulations. . “To run a business successfully, the general manager requires an absolutely free Jia nd within the limits of the policy and objects of' the business as laid down by his board of directors. He must be permitted to engage his employees, dismiss them or promote them, without lot or hindrance . He must be able to buy and sell *t the most opportune moment. He would be dumbfounded

if he were informed, for instance, that he must not have his account books printed without authority from, say, a committee of managers of other businesses; that for certain lines he must , deal only with one firm; that all building operations must be designed and carried out by only one firm, who might be overwhelmed hy other orders, and whose difficulties in obtaining competent men and paying them adequate wages for overtime might be as insurmountable as his own, owing to their being, hampered, liko himself, by restrictions and regulations. If he found a man whom he considered particularly suitable for a particular position in the firm he would be astounded if the employment agency with whom his articles of association required him to deal informed him that, however much they. might sympathise with his request; they were unable to employ such a. man. If he found he had an exceptional employee whose energies had increased his .business by some thousands of pounds, and he wished to ensure the retention of this employee’s services , and to reward him for his good work by raising his salary by a mere hundred pounds a year, he would be dis■j gusted to be informed that his proposal could not be given effect to. , “In fact, if at every turn he found that he had no power to perform but only to recommend and that his recommendations had to be made to various business firms engaged in businesses of a totally different description from his own. and therefore not closely acquainted or necessarily sympathetic with his requirements, and to whom ' hit, urgencies were of little consequence, he woild probably "throw up the sponge” in .disgust; and would undoubtedly do so if, after surmounting all these obstavies and having smoothed the way for the successful launching of an extension of his business, he found the directors, owing to the failure of their investments in other businesses, or if they required the, money for other enterprises, just when his organisation was complete and the time most opportune for launching his enterprise, declined to authorise such expenditure, and, moreover, proceeded to draw out some of their capital from the business. ' Gradual Improvement“We can imagine the retort being made that if the Government service is in such a condition as the above, then it is time to tear down the whole edifice and reconstruct the same on some more sensible basis. Nay, nay 1 that would be just as foolish a conclusion. An improvement in these matters is gradually and surely taking place, and is apparent every day. The officer whe has proved himself to bo truly efficient is allowed’considerable latitude within certain limits, and is subject to a minimum of nterference. We have above pointed out that the methods of administration of the Civil Service, though not suitable for business enterprise, are possibly the best that can be devised for the purpose of general government. It must always be remembered that the methods of government must be framed with a due regard for human nature, and that schemes so often urged as ideal are suited only for a community of much more perfect human beings than exist at present. . . . “No system is sound in theory that is not sound in practice. To allow unlimited and autocratic powers to any individual, and to give him the full running of a State enterprise without the salutary check that is imposed in a business concern where the management’s salary and security of employment is dependent upon the profits accruing, would not be a sound or workable arrangement. The majority of the- Departments of State are what are known as ‘professional Departments’ —i.e., they aro Departments the permanent heads of which require to be, and are, possessed of scientific skill and experience in certain specialised and therefore limited directions. The various Departments of the service are admirably suited for workisg as a whole, and helping each other in directions where- their individual expert knowledge and machinery is invaluable to other Departments who do not possess such. It must be admitted, however, that the needs of one Department will seldom be recognised as of paramount importance by another, and are not likely to receive the prompt attention that the Department itself would give thereto, or that a business man engaged in the pursuit of his own business would demand. Yet, generally speaking., it is better that a Department specially qualified and equipped to - perform certain services should perform them for the rest the service, rather.than each De-

partment should set up its own machinery, thus resulting in the multiplication of various small and in-many cases inexpert bureaux performing work that could be mor.e efficiently and economically performed by a specialised Department.” Combination of Advantages.

After admitting that the Public te-day is in a more efficient condition than ever before, the journal adds: “From the foregoing it will he seen that the suggestion, that the, hospitals should be nationalised requires very careful consideration, before any support is given to it. Under the sent system the hospitals are controlled 'i by representatives of the electors of the contributory local authorities, who are directlv responsible to the ratepayers for‘the expenditure of money levied for hospitals. No increase in expenditure can take place without criticism and a request for an explanation of such—at the very doors, as it were, of the institution—from those who are asked to pay the money therefor. The services of keen local business men are, moreover, available for administration of hospital and charitable affaire in the district: and finally there is a thorough inspection, control, and check bv the Department in every branch of the administration, and the. inspection recently has been and is being greatly' extended. “Tho advantages, therefore, of local administration are combined with the advantages of skilled advice and inspection by a Department expert v every direction, and thus there ,is a r.alutarv check upon the administration. Would such exist if the Department administered the institution. Governmental control and administration may not always be the best—noi that its'administrators are in any way less competent or efficient than others, but they have their bands frequently tied by regulations and restrictions, and are hampered bv that lack of freedom of action so necessary for the reallv efficient running of a complicated business machine. The hospitals would not be controlled by the Health Department entirely, but in many directions by the Health Department in collaboration with other Departments, who would have no particular interest in the institutions. Moreover. if the hospitals were administered bv t l ’" v»c”'>rtmcnt, which previously cxcrc’s'-'l t''c financial cheek and controTTin" inlb'C'ce. who would undertake these relinquished functions? Who, also, wbuld protect the Dcpart- ' uront from the pressure and clamour of Huron sou able that would be bound to arise if all the- money had to be provided out of the Consolidated Fund? The public --’I never learn that no matter whether the money is provided by rates or by taxes il is the public who nav: and whilst under a local body administration we might find great opposition to some expensive undertakings on account of toe cost, vet under a tate administration we wbuld actually find the greatest clamour for the same undertakings from the very persons who in the other case would have opposed it. A Minister cannot travel through any part of the country without being waited upon bv deputations for grants or assistance for works that would bo desirable enough if thev could be a Horded. Would we see the same deputations to the focal authorities of the ratepayers asking for the same money t<> lie spent for which they would be directly rated?”