MANAGEMENT OF HOSPITALS.

Evening Post, Volume LXIX, Issue 50, 1 March 1905, Page 2

MANAGEMENT OF HOSPITALS.

ADDRESS AT THE MEDICAL CONFERENCE. TllK EFFICIENCY OF BOARDS. UNIFORM METHODS OF ADMINISTRATION. [UT TELKOKAPH — I'ttESS ASSOCIATION ] AUCKLAND, 28Ui February. The conference of the New Zealand branch of the British Medical Association opened to-day. In his address as President, Dr. Robertson took as his subject "The Management of the Public Hospitals in New Zealand." The jiddrebs was a plea for legislation to increase- tho oflicioncy of tho managing Boards. Tho oft-i-ecuuing disputes in connection with hospitals were attributed to the unnuHability of the Boards an at piesent constituted, owing to want of expert knowledge or other special qualifications, for their work— deficiencies most apparent in the larger hospitals, owing to their greater complexity of organisation. SIiLF-SUFFICIENOY OF BOARDS. Tho Boards of tho belter managed of those hospitals, wnid Dr. Robertson, had trusted in well-chosen expert advice, but tho majority of the Boards, elected on a limited choico of local bodicß, had a tendency to net on their own xelfBuflieiency. Public hospitals w ere practically State institutions. Tho Ilo»pitula and Charitable Aid Institutions Acts of 1885 and 1886 were designed entirely to provide- funds for their maintenance — tho question of eflioiency of management, apart from economy, was not considered. These Acts wore passed because the General Government wan the last resourco of imprcunioua and embarrassed hospital committees. After the abolition of the Provincial Governments, Sir Julius Vogel had introduced measures to relieve tho Consolidated Revenue by throwing part of the cost on the local jntea, and thia was done, The Acts were acknowledged by their fraiucrs to bo Until! ivo measures, and their deficiencies wero apparent. After twenty years they had fulfilled their main miiposa of providing funds by tliu apportionment of expenses fair to nil parts of the colony, but further steps should now be taken to provide, moie pflicient mnnauenu-nt. Tho ln*»peelorGeneral had the power of reporting on hospitals, but no control. HOSPITALS AND ASYLUMS. A contrast was drawn by Dr. Robeitson between hospitals and asylums, of both of which tho Inspcctor-Uonernl is the ofiicial head. The asylum uervice — in which tho Inspector-General had tins power of control and organisation, and consistent management — held tho ontiio confidence of the medical profession, and was one of which any country might be proud. The hospitals — of which ho had no renl control — were a constant sourco of complaint to the InspoctorGeneral himself, to tho medical profession, and to the public. Some centra! control was needed. In support of this was adduced tho fact that there was a similar incroaao in size and bimilar development of hospitals throughout the colony, requiring larger buildniyn, mote lomplex staffs, and different chuMlicntion of patients from time to time. Waste of money and oncrgy wcr.- cnused by tho petty experimentation of local" Boards or Waffs to meet chaugid conditions, where the oxptiiem'i! of others already showed a better wny. Purely local government, us applied to huapital\ hud prcm-H v fii lure', and some central authority Flu.uld. within limits, control tho wet ion of Lilldmgs and lay down system* of internal management, according to the i-laasihVa-lion of hohpi to to, b.tsud on size and other circumMunces. THE WORK OF BOARDS Tho doctor claimed that uniform methods of administration would obviato much of tho trouble and friction which were liable to occur. It would make possible the training and promotion of eflW cienb officials, und enable tho choice of thoßO of tried efficiency to fill posts requiring special qualifications. It would prevent changes to satisfy tho whim of a fad'Jist., or the personal advantage of v solf-soekcr, whethor lay or medical. Local boards would still bo necessary, and should bo distinct from those controlling charitable aid. Tho two kinds of work required men with different qualification}!. Tho lesser time occupied by the work, owing to its limitation through contral control, would enable many men, at present excluded by tho time roquired, to bo members of Hospital Boards. There would thus bo more members able to understand und sympathise with tho aspirations and ideals of thotio engaged in hospital practice. At present tho Boards and staffs were notfin sympathy. Mutual distrust wat. pernicious. Registered medical practitioners might fairly claim representation on Hospital Boards, as being the only body of men whoso profession and training and life-work fitted them to, understand the dot ails and necessities of hospital work. Local bodies were, and tho Ginernl Govornment Bhould bo, represented, on account of their contributions to the funds. Where honorary staffs exist thoy ought likewise to havo representation on the managing Boards.) This question was virtually settled in Britain in connection with a dispute at one of tho large London hospitals in 1001. The interest then orcated led some sixty of the senior physicians and surgeons of London hospitals, headed by Lord Lister,' to record their conviotion thai representation of honorary staffs on boards of management led to harmonious working and efficient management. A joint committee of business and professional men confirmed this aftor strict investigation. ELIGIBILITY FOR ADMISSION. Tho noccssity of members of Boards boing appointed for more than one year was shortly referred to by the doctor. Tho test of eligibility for udmission was dwelt on at some length. Tho principlo that public hospitals were charitable institutions wan recognised by the framers of the Acts of 1885 and 1886 in their encouragement of voluntary contributions. The tendency was for well-to-do people to look for gratuitous assistance in sorious sickness at the expense of the ratepayers. If this wore permitted a clear injustico was done both to tho ratepayers and members of tho medical profession, especially thoso who garo their honorary services. To cure this abuse, the clause of tho present Act which states that each patient shall pay a reasonable sum according to his inwiiis should be strictly enforcod. The objection that this would ronder an invidious enquiry necessary was mot by the reply that tho State already insisted on such enquiry in regard to incomo tax, applicant* for old ago pensions, and oven parents of children winning national scholarships.