HOSPITAL CONTROL

Evening Star, Issue 17710, 11 July 1921, Page 3

HOSPITAL CONTROL

GOVERNMENT CONTRIBUTIONS - . AND. FEES CHARGEABLE.

ROYAL COMMISSION’S REPORT.

SUPPLIES PURCHASE BOARD

ADVOCATED,

■ Many important proposals are contained in tho report of tho Commission appointed to inquire into hospital control and allied matters; which was made- avaifable for publication by the Hon. C. J. Parr (Minister of Health) on Saturday. The Commission’s findings, which appear in some vital points to endorse the views expressed by the Minister last session, are summarised ns follows :

1. (a) The Government should contribute one-half of the capital requirements of hospital boards. The basis of seen contributions should bo a flat rate subsidy of £ for £ on the capital expenditure and on interest on loans current in respect of capital expenditure, (b) The cost of minor capital works, and all plant and equipment should ‘be provided for otherwise than from loan. The cost of erecting buildings, or of making additions or alterations to buildings, or purchasing land may be raised by loans. Loans should be repayable by a sinking fund within a period not exceeding twenty years for permanent buildings and mud, ten years for wooden (where non-perma-ncnlj buildings. The Government should provide facilities for hospital boards to obtain loans on the most advantageous terms

2. (a) The Government should contribute one-half of the net requiremeuts ot hospital boards, (b) Ibe basis of allocation of 19-20ths of such ! contribution among individual boards should be on the principle that the heavier the burden of a board’s requirements on i the rateable capital value of a district the higher the subsidy, but that the rate of subsidy, per £ of levy, should not <-x----ccwl 25s,“nor be less than 14s in the case of anv individual board. The remaining 1-20tli of such contribution should be specially allotted in equal to hospitals at Auckland, Wellington, Christchurch. ami Dunedin for the purpose of developing and -extending the work of special departments essential to such hospitals, but should not be used in any ease for ordinary maintenance purposes. In view of the special subsidy contribution, other hospital hoards should have the right to send patients for admission to those hospitals for special treatment, on payment of the maintenance fees. In arriving at the burden of a board’s requirements on the rateable capital value of its district, a deduction should be made from such rateable capital value of all non-rate-producing Native lands. 5. The Government should subsidise voluntary contributions to hospital boards for general maintenance purposes, or for special maintenance purposes approved by the Minister, at the rate of £ for £. The Government should, on the recommendation of the Minister, subsidise voluntary contributions, bequests, and devises for capital purposes, or endowments, at the rate of £ for £.

4. (a) The Mercury Bay Hospital should bo merged in the Coromandel Hospital district. (b) Oamaru Hospital should continue to be treated as a separate institution under the Hospitals and Charitable Institutions Act, and receive the same scale of subsidies as a hospital board, (c) The Jubilee Institute for the Blind in Auckland is an educational institution, and, as such, should be removed from the list of separate institutions under the Act, and in future should receive financial assistance from the Education Department, (d) Tho Reefton Ladies’ Benevolent Society should ‘be removed from the list of separate institutions and be affiliated with the Tnangahua Hospital Board, (e) The Wellington Convalescent Home, St. Andrew’s Orphanage (Nelson), the Wellington Ladies’ Christian Association, the Hawke’s Bay Children’s Home, and the Wellington Society for the Relief of the Aged and Needy should be continued as separate institutions, and receive the same scale of subsidies as hospital boards on voluntary contributions and bequests. 5. The Plunkht Society and the Salvation Army should continue to receive financial assistance from the Government through the headquarters of each organisation. The Government should make an annual grant to other charitable societies and institutions, and allow the same on tho recommendations of hospital boards, having regard to the amount of voluntary contributions and the number of inmates. FEES AND PRIVATE WARDS.

6. (a) A uniform fee of £3 3s per week for adults and £1 11s 6d for children under fourteen years of age should be charged for maintenance and treatment in public -hospitals, boards to have permission to roduce such fees in necessitous cases; boards to have power to contract with friendly societies for the maintenance and treatment of their members on a guaranteed payment of one-half the above fees, (b) In order to extend further their usefulness, there should be established in connection with public hospitals, wherever the conditions are favorable, private wards to which patients would be admitted on payment of adequate fees for maintenance and noising attendance, such wards to bo under tho control of the medical superintendent, but patients to choose their own medical attendant and make their own arrangement ns to his fees. 7. (a) Section 9 (2) of the Hospitals and Charitable Institutions Art. 1909, should bo amended so as to allocate representatives of contributory districts in proportion to their respective rateable capital value and population in the ratio of twothirds on the rateable capital value and one-third on (b) The existing system of representation and suffrage should continue, except where local contributory bodies, having different forms of suffrage, are united in one combined effort. In such a case tho ratepayers’ suffrage should apply over the whole area. 8. Considering the full power- of control of espßndituro i already possessed by the Minister, Government representation upon hospitals boards by means of nominated members is not recommended, except that, in the case of the Auckland, Wellington, .North Canterbury, and Otago Hospital Boards, to whom it is proposed to give special financial consideration for base hospital purposes, it is recommended that there should be one member on each board appointed by tho Government, and, further,/ in tho case of tho Otago Hospital Board, an additional member should be appointed by tho Government to be nominated by tho medical faculty of the University of Otago. 9. The constitution and area of hospital districts should continue as at present, except that the following hospital districts should bo amalgamn’nod ; —Picton with Wairau, Inangahua with Grey, and Waihi with Thames. The public hospitals at Auckland, Wellington, Christchurch, and Dunedin should be constituted base hospitals. Economy, tic Commissioner thinks, would be effected to a very large extent by the adoption of the following recommendations:

(a) A Hospital Supplies Purchase Board should be constituted under the Health Dopavtmenut, composed o£ one responsibl officer of and appointed by each of th four base hospital boards—one from the Health Department, one from the Mental Hospitals Department, and _ two business men nominated by . the Minister. The board should arrange for _the_ standardisations, purchase, and distribution of equipment and supplies for all the institutions under the hosnital boards, Health Department, and Mental Hospitals Department. Hospital equipment and supplies whore possible should be standardised, with a view to economical buying, by placing combined orders for delivery, at centres as required. (b) An inspecting house steward should be a permanent officer of the department. He should introduce an efficient system of recording and checking the receipts and the issue of supplies at each hospital, and should report fully to the department and the Hospital Board affected after each inspection. (c) Two inspecting accountants should be appointed at once to introduce a uniform system of accounts and returns. They should introduce a uniform system of costing.

(d) With a view to assuring the most efficient design and construction of hospitals and standardising ot buildings where possible, a specially qualified architect should be appointed. 1 (e) A skilled dietitian should bo appointed at once by tho Otago Hospital Board to organise at the Dunedin Hospital, in connection with the homo science department of tho University of Otago, the training of pupil dietitians. As soon ns possible dietitians should bo appointed at Auckland, Wellington, and Christ-

church Hospitals by the respective boards. (f) A uniform system of medical records should be introduced into all hospitals. (g) It is suggested that as additional accommodation for patients becomes necessary in the largest centres a policy should be considered of building secondary hospitals for convalescent and chronic oases. (li) In section 72 (1) of the Hospitals and Charitable Institutions Act, 1909, in line one, after tho word? " when a person receives.’’ there should be added the words “charitable aid,” and a clause should be inserted in it amending tho Bill empowering boards of Auckland, Wellington, North Canterbury, and Otago hospital districts to recover from another hospital board tho cost- of special treatment given by any of them to anv bona tide resident of that board’s district.

(i) Medical research aiurpreventive work of the Health Department should he further developed, with a view to improving the national health, thus lessening the need for hospital accommodation.