HOSPITAL POLICY

Dominion, Volume 26, Issue 29, 28 October 1932, Page 8

HOSPITAL POLICY

Report of Commission BOARDS MAKE REPLY Dr. Begg Enters Protest 1 Following upon a meeting held in Wellington recently, the executive of the Hospital Boards’ Association bus drawn up a reply to the National Expenditure Commission’s report on hospital administration. When the statement was placed before the Wellington Board yesterday, Dr. R. Campbell Begg said that if there was ever a less constructive document be bad yet to see it. He gave notice to move at the next meeting, when the statement will be discussed, that the board withdraw from the Hospital Boards’ Association. “That portion of the report of the Commission which criticises hospital administration oilers many points of attack, and it is felt that. some of the findings, if made by a special investigation into public hospital affairs after exhaustively sifting the whole of the facts obtainable, would be remarkable/’ the statement says. “Vital Factors Ignored.” “In the report, figures are tabulated showing the growth of expenditure on hospitals and charitable aid from £533,507 in 191-1 to £1,930,654 in 1931. No mention is made of the very substantial economies effected last year. The Commission ascribes the increase almost entirely to the fact that there are too many hospital boards and ignores the following vital factors:— (1) The trend towards more use of institutional treatment encouraged by improved facilities, improved medical and surgical skill, and an increased confidence in our public hospitals on the part of the nubile. Better provision for T.B. and other chronic eases—development of■ sanatoria. This trend is the case the whole world over, and no doubt is reflected in improved health conditions. (2) Decrease in purchasing power of money. In 1029 money had 38 per cent, less purchasing power than in 1914. and 25 per cent, less than in 191 - (3) Charitable aid has increased from 1014 by the startling amount of over X-00,-000 per annum. , , . , (4) The very considerable increase .in motor and Industrial accidents and the heavy losses iu fees occasioned thereby. (5) Improved conditions in hours of duty of nurses and their remuneration. Also in remuneration of staff generally. (6) The inauguration of a superannuation scheme has cost an additional £lO,OOO per yC (7) Increase in population of 350,000 persons. “Further, it. may be mentioned, the cost of treatment of ex-soldier cases should not be lost sight of when comparing expenditure with those earlier years. Also there should be taken into, consideration the post-war economic position necessitating many more receiving hospital treatment through taxation. Is there a single one of the above factors which would not have operated had the system, as recommended by the Commission, been in operation over those years? . . . Responded To Economy Call. “The Commission doL not appear to have been aware that all patients in the North Island admitted to sanatoria have the payment of their fees undertaken by hospital boards and the fees so paid approximate .the cost of maintaining these institutions. Thus the burden falls equally in the North and South Islands. Moreover, the cost of sanatoria-in the South Island as administered by Hospital Boards has been eased by Government grants. “It is quite wrong for the Commission to imply that there has been no review of the hospital system since 1909. It has, in'fact, been constantly under review since that time and has been the subject of many Inquiries including the Hospital Commission of 1920, of which Mr. Shirtcliffe was a member. “The Commission states that the existing powers of the Minister have not served as a check on the ever-growing hospital costs. This merely emphasises the failure of the Commission to appreciate the real causes of this increase. It is pure assumption that the new order of things as recommended by the Commission should have had any greater effect. It has been amply shown that hospital boards have responded to the urge, for economy at least as readily as any of the other local bodies.” Referring to the relatively small voluntary contributions to hospitals in New Zealand, the statement points out that countries which have relied on contributions have drifted into great financial difficulties and have required Government assistance and recourse has been made to lotteries. Question of Centralisation. “The commission states that the forty-five hospital districts are no longer warranted, and later recommends a reduction to sixteen or eighteen. The Hospital Boards’ Association at the conference in June endorsed the principle of "amalgamation through a process of mutual agreement and understanding between the hospital boards themselves. “It might well be asked, has the commission attempted to indicate the real factors leading to the subdivision of the hospital districts? It may be remarked that at present the subdivision of a district can only be effected by Act of Parliament. Experience shows that the small district is not necessarily expensively administered while having a more favourable experience in collection of fees. Nor is the large district the most economical. All that can fairly be said is that, within certain limits, the larger districts tend to facilitate economical administration. This can, perhaps, best be realised if we can visualise one board for the whole Dominion. Surely there is a point where centralisation must cease to be economical and tend to become expensive.

"While drawing attention io the present forty-five hospital board districts being too many for the control of hospital activities the commission later on in the report recommends that charitable aid should be administered by the three hundred and thirteen county councils, borough councils, and town councils. Surely this is a paradox? “The recommendations of the commission for the setting up of a ‘board of hospitals’ are familiar. Somewhat similar recommendations originated from the New Zealand branch of the British Medical Association in 1926. The idea was recently developed by Dr. R. Campbell Begg. “The commission commends the New South M’ales and the Victorian systems as a precedent. These are not hospital systems iu the proper sense of the word, but merely represent an attempt to co-ordinate the work of numerous independeut institutions. The position in both these States is not such as to encourage the adoption of their schemes of hospital finance or administrative machinery. “As regards New South Wales the desired objective is definitely in the direction of obtaining a system of hospital finance similar to that of New Zealand which, by the way, is the only country in the world which has a fully co-ordinated hospital system with assured finance.”