OVERDUE REFORM

Evening Post, Volume CXIV, Issue 101, 26 October 1932, Page 15

OVERDUE REFORM

LOCAL GOVEENMENT

RATIONAL ORGANISATION

CHARITABLE AID AND . HOSPITAL BOARDS (By K. Campbell Begg.) "One can readily understand that the work of a charitable aid board is substantially different from that of the management of a hospital. You will find people who will devote a great deal of time to hospital (-matters who would not be qualified to take up charitable aid work."—Mr. Hanan, Invereargill. 1909 debate. "So long as the State gives money out of the Consolidated Fund and allows towns to tax the country, what hope is there that this problem (charicable aid) will be seriously faced." —Dr. McGregor, Director of Hospitals, 1888. Parliamentary Report. "Is it consistent with common sense, first- to.-'wring;.money from the people by taxation-and then :go 'through the sham of giving;/it,:b^.cfe:to them .in;,th';e-|orm of subsidies?H's^Vnld : jVj it6t-;be mpr.e;. ; 6iniple and effective.'t6^lefr:-each«;^isti;idtvidbkJ after its own:afiairs?'ft^nTlSlJV^BatSlite. Debate on Charitable institutions-Sill, 1885. "The districts Spending the money should furnish - one-half at. present and. the whole eventually.' Five years is enough. The sooner the. Government .'. contribution ceases .the better."—Sir F. Whittaker, Hospital, and' Charitable Institutions Bill, 1885. . ;;■ ,-• ■■:':'■ " Recently in. England, a great reform in- hospital administration took place when' the! -649 Boards of Guardians, representing unions or small •groups of pai-islfes, relinquished "the " combined functions of charitable aid and direct hospit&l-;control. ;■', These 'separate functions were put under the control of the laTge counties and county boroughs which -also dealt with health matters, education, housing, food inspection, river pollution; and innumerable other matters. Hospitals as illustrated in the organisation, of the London County Council which, serves a population four or five times that of New Zealand were allotted to a special committee. The other matters each hav-e their own committee, and the expenditure of all is ■ irefully controlled by a small finance committee, which has to sanction all expenditure. . '. >. The result of placing the control and management of hospital matters in the hands of a separate committee has-resulted in revolutionary changes for the ..better in the poor law hospitals, while the co-ordina-tion of health, social services, education, and hospitals under the general administration of one large and financially powerful body makes for the scientiile handling of the problems of prevention and cure of destitution, whereas under the sole control of the Boards of Guardians hospitals were limited in scope and indifferently conducted and the care of destitution was restricted largely'to the mere doling out of relief. ••■ A' CUMBERSOME'SYSTEM. "A •BUI to organise the "local government of New Zealand on somewhat similar lines was presented to the House of Representatives by Sir Joseph Ward in 1912. This made provision for,the division of the whole of New, Zealand into 24 provinces corresponding to the counties in England. Under.the terms of this.Bill the Provincial Council was to control by means of. separate committees .the divisions of hospitals, charitable aid, health, education, highways and main roads and .bridges, drainage, water supply, and harbour boards, the whole to be coordinated by a Local Government Board in Wellington.- ---■ The National Expenditure Commission expressed approval of the general principles of this Bill, but unfortunately the Commission's order o f reference did not include a' general: survey of local government,.:so, that in- regard." to hospitals and'charitable aid it was compelled to suggest an alternative scheme which could be put into force even under the present unsatisfactory system, which has prevailed and become increasingly cumbersome and "unworkable ever since its initiation in the travesty of Sir 'Julius Vogel's County Bill as passed into the-Statute Book and subsequently modified by the further splitting up of counties in order to secure more government subsidy.' In recommending a limited number of .more or less uniform hospital districts the Commission is simply reaffirming the principles of the Bill introduced by Sir Julius Vogel and'• Sir Rbber,t Stout in 1885-based on the report of Dr. Grabham', the Inspector of and of that 0f.4?06 introduced by Sir George Fowlds on the ie,eori)mendation of Dr. McGregor, Diree-jto-r-';of Hospitals, which was. afterwards* (with slight modifications) .submitted to a Hospital Boards Conference in 1908 by Dr. Valintine, who strongly advocated its adoption. Both these Bills were so mutilated as to destroy their intention by. the time they had passed into law. CARDINAL PRINCIPLES. ' In the matter of charitable aid the Commission has made a different proposal to meet conditions as they actually exist. It has recommended that the function of charitable aid bo removed from, hospital boards, on the basis that the effective treatment of destitution is not possible by these.' bodies. There is no doubt that in supporting his Bill in 1908 Dr. Valintine was handicapped, as every reformer of one section of local government has been hampered, by the complete absence of rational large local body units who could co-ordinate all the activities which must largely influence tho inci-. denco of destitution. He proposed what was probably the best under the unfavourable circumstances, namely: (1) A limited number of hospital districts, each large in area and having a large town as a base, and a large capital value so .as to render it financially strong. f■,. :" ' " ■J-"(S) The administration-, of health matters as well as hospitals and charitable aid to be undertaken by each of these powerful local body units. (3) The power of tho boards to coopt those with experience of the treatment of destitution oil the special committee to deal with this part of its work. (4) A Government subsidy of 10s in the pound. The basis of this subsidy was certainly that money from the Consolidated Fund should be available during the period of. expansion and for the- handling of such diseases that had a' more immediate public health aspect, such as tuberculosis and venereal disease. There is no" indication that it was considered that a subsidy should be used for charitable aid purposes, which is properly a tax on wealth and therefore should be supported by local taxa; tion. These cardinal principles stood or fell together if the purpose of the Bill was to be carried out. The violation, of any one- of them really, meant the disruption of the whole scheme, and history since that time has shown only too clearly the truth of this. . Instead of a limited number of strong districts a large number of weak ones have been formed. A co-ordinated hospital service thus became impossible/ The administration of health had to be abandoned and the treatment of certain diseases and nursing administration thrown back on the Government. With the relinquishing of health administration tho boards had no means at their'disposal for the preventive treatment of destitution, and their activities resolved themselves

largely into the mere doling out of relief. In addition, they refused to coopt experts to their social welfare.committees, but elected to carry on ■ this activity as well as hospital management with their own personnel. V ADMINISTRATION OF RELIEF. The administrative machinery did not permit of the boards maintaining offices and staff for relief purposes in outlying districts and this work was thrown on board members themselves who not only were beset with applicants in their own houses but had nol ■means: of investigating the genuineness of the eases. No doubt all these considerations led the Commission to propose that the county and borough councils who had offices and personnel in' these various districts should take over the administration of relief. That ; this is by- no means a fantastic suggestion may be illustrated by the fact that, in such a, well governed country as Sweden in regard to hospitals, the actual giving of relief is entrusted to some 2500 communes. At the same time, one cannot agree with the Commission in recommending the continuance of Government subsidy to these local bodies. The essence of such distribution of relief in an economical way seems to be that the money should be obtained by local taxation, though the problem of the migration of paupers into the centres raises difficulties difficult of solution.. As Dr. McGregor, ■one of the most thorough students of charitable aid in. New Zealand, stated: "Nothing, I am persuaded, but the tax gatherer at the door will make towns organise themselves to stamp out the professional pauper by separating, on full and" discriminating inquiry, the sheep from the goats, the deserving from the undeserving poor." The solution of these problems of relief are not easy, and handing the work over to thei individual local bodies will not help the question of prevention and cure, but at least these bodies can hand out charity more effectively tha,n rhe hospital boards, who likewise are Impotent in Tegard to the major problems and should welcome, .the opportunity of'devoting"themselves to their main work, the control and management of hospitals. TIME TOR ACTION. Nothing really effective will be carried out until New Zealand possesses large and powerful nnits of local government to replace the numerous Power Boards, .Harbour Boards, Highway Boards, etc., under some well co-ordin-ated system of ■ provincial or county government though as far as the pure administration of hospitals is concerned jthe'jfor'maitibn of. rational, uniform, and well-organised hospital districts, "even underlprea'eiat eireumstances .will 'go a long ,Tvay;to solve that particular, problem. For this we have waited for over half a century and are likely to wait another unless the responsible government realises that the people expect it to take action on their behalf irrespective of the few local body memtiers who think, that their particular corporation must remain inviolate whatever the needs of the country are for sound and economical local government. . ~;.: . . The t lplUjwing statement, ; w,as jnkde by a.<pUiiii(S;ihlan, forty-three-jears-ago. It could still be.'made to-day:—. "The disruption and division of our institutions has, I believe, 136611 allowed to. proceed so far that now. at length it las .resulted in a reductio ad absufdum. What with the 'multitude of - finunicipalities, County Councils, Road Boards, Harbor Boards, Licensing Boards, and School Boards we are almost in a state of adminisitr)a.tive paralysis from the impossibility .of organically co-ordinating their functions."