BOARDS' CRITICISM

Evening Post, Volume CXIV, Issue 103, 28 October 1932, Page 11

BOARDS' CRITICISM

.POINTS OVERLOOKED

"A. copy of -what was described as "the considered opinion of the executive of the Hospital Boards' Association" on the Economy Commission's report so far as it relates to hospitals was brought before the Wellington Hospital Board at its meeting yesterday. The executive said that the present system did not facilitate an increase in levies if subsidies were reduced, for last year and this year reduction in levies and subsidies went hand in hand. Criticism is made by the executive that no mention was made by. the ■ Commission of the very substantial economics in expenditure which were effected last year. Vital factors which had been ignored by the. Commission when dealing with expenditure include the trend toward more use of institutional treatment encouraged by improved facilities, improved medical and surgical skill,■'■and an increased confidence in public hospitals on the part of the public, better provision for T.B. and other chronic cases; decrease in the purchasing power of,money; the charitable aid increase from 1914 by the startling amount of over £200,000 per annum; very considerable increase in motor and industrial accidents and heavy losses in fees occasioned thereby; improved conditions in hours of duty of nurses and their remuneration, also in remuneration of staff generally; inauguration of a superannuation scheme costing an additional £19,000 per year; increase:!in. population of 350,000 persons. Further, the' cost of treatment'of ex-soldier cases—still an important item—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. SANATORIA CHARGES. The Commission did not appear to have been aware—aa it should have been —that all patients iv the North Hslaud admitted to sanatoria had the

payment of their fees undertaken by hospital boards and the fees so paid approximated the cost of maintaining these institutions. Thus the burden fell equally, in the North and South Islands. Moreover, the cpst of sanatoria in the* South Island as administered,bj .-hospital boards had been eased by Government grants. , Hospital boards had responded to the urge for economy at least as readily as any of the other local bodies. - ;'; It should be pointed Vout—as tho Commission should know—that countries which had relied" on voluntary contributions, for example, ;New South ■Wales; and Victoria, had, drifted into great financial difficulty in financing their hospitals and their Governments had had to come to the rescue. Also, the questionable recourse to State lotteries has been made. ■' ■ With regard to the recommendation that the number of hospital districts should be reduced from 45' to 16 or 18, the executive stated that the association at the conference in June had endorsed the principle of amalgamation through a process of mutual agreement and understanding between the hospital boards" themselves. At present the subdivision of a district could only be effected by Act of Parliament. Experience showed that the small district was not necessarily expensively administered while having a more favourable experience in collection of . fees: Nor' was the large district the most economical. All that could fairly be said was that, within '.certain limits, the larger districts tended to facilitate economical administration. "A PARADOX." "Whilo drawing attention to the present 45 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 tho 313 county councils, borough councils, and town councils. Surely this is a paradpx," comments the executive. "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 tho British " Medical Association in 1926. Tliqy are.designed to take over powers at present held by'the* Minister, the Department: of Health; and the hospital boards themselves. The idea was recently, developed by Dr.' B; Campbell Begg. It may be pointed out that the Hospitals Commission: of New South Wales is a non-political body with the power to close hospitals, and\,has closed none. The Charities Board of Victoria is also non-political with similar power which it has not exercised." In Australia, between the four years 1924 to 1928, the number of hospitals increased by 37, and the number of beds by 1600. The number of in-patients treated increased by 75,000. The'inference may therefore be taken that hospitals arc not established for political reasons, but to meet the needs of the communities which they serve." . .'■'•.'. ; The Commission had commended the New South Wales and the Victorian systems as a precedent; but these were not hospital systems'in the proper senso of the word, but merely1; represented an attempt to co-ordinate the work of numerous independent: institutions. The position ,in.both'those States was not such as -to encourage: ,the adoption of their.schemes, of hospital finance or adminisfrativeimachinery. New South Wales .desired to obtain a system of hospital, finance similar to that of New Zealand, which, by the way, was tho only country in the world which had a fully co-ordinated hospital system wi,th assured finance. It was interesting to note that under the comparatively recently organised London; County Council Hospitals, 68 per cent, of the patients were treated as a burden on rates. .■; >'.v.'•'■'".: .'>'.'■'. --V.-' ■ CAREFUL CONSIDERATION NEEDED. ~ ;-':. The chairman (Mr. JF. Castle) said that any change of policy would need fresh legislation. He thought that,'consideration, of.the Commission's recommendations should be deferred. Dr. E. Campbell Begg said that Mr. Wallace, chairman of the Auckland Hospital Board, stated at the last meeting of that body that he wished to give evidence, but nobody had been, given an opportunity of appearing before the Commission. Was it within the knowledge of the Wellington Hospital' Board that the Hospital Boards' Association submitted a "statement -to the Commission? .."_••■ :.,-.. Mr. Castle: The Commission invited persons to give evidence. The Hospital Boards' Association sent a statement to the Commission. ' Dr. Begg remarked that the position was an extraordinary one. The Wellington Hospital Board was a member of the association and subscribed to its funds. It was an absurdity to say that no opportunity had been afforded to give evidence. He criticised the circular letter which had been sent to hospital boards. The executive of the association had put the position before the Minister of Health. The chairman, rose to a point of order, and questioned whether Dr. Begg was justified at the present time in criticising the Hospital Boards' Association. . ..., - Dr. ,Begg moved that a special meeting of the board v be held to consider the question of withdrawing from the association. ' ' Mr. CM. Luke moved, that consideration of tho circular of the association be postponed until the next meeting of the board. Dr. Begg agreed to Mr. Luke's suggestion, and gave notice to move at the next meeting of the board that the board withdraw from the association. The consideration of the association's circular was deferred until next meeting.