THE DISTRICT NURSE

Hawke's Bay Tribune, Volume XIX, Issue 281, 12 November 1929, Page 3

THE DISTRICT NURSE

MORE HOSPITAL BOARD DISCUSSION

QUESTION OF £lOO PAYMENT.

TROUBLE OVER PAYING FOR DRUGS AND DRESSINGS.

Further light was thrown on the financial relations of the Hastings District Nursing Association and the Hawke’s Bay Hospital Board at the meeting of the latter body yesterday afternoon. A lengthy discussion arose through a letter received from Messrs Rainbow and Hobbs, treasurers to the association, in regard to the sum of £lOO which the board some time ago agreed to place to the credit of the association and, further, in connection with an amount charged for drugs and dressings. The board finally disposed of the whole matter by referring it to the Director-General of Health for a ruling. The treasurers to tho association, in reply to the board’s letter, wrote as follows

“We note that the £lOO voted some months ago, and over which there was some discussion during the meeting which took place between us recently, has not yet been credited to our account. We hope that there is no further misunderstanding with regard to this £lOO but we certainly expected to find it to our credit before September 30. We enclose herewith a cheque for £lOO for our credit in your books. This, of course, will carry subsidy. “There is another item which the members of my association question, and that is your charge for £lB 5/10 for drugs and dressings. Nurse Cassin informs our association that these drugs and dressings have been used by her on the out-patients of the hospital whom she has attended in Hastings, and not on the people on whom she attends as the nurse of the association. This being so, our members consider that no portion of this amount should be charged to us, and we will be glad if you will make such representations to your board as will enable them to authorise the re-crediting to us of this amount.” “A VERY SORE POINT.” Mr. C. 0. Morse (chairman): This £lOO seems to be a very sore point. It should be shown to their credit in some way. Mr. E. T. Rees (secretary) : It could possibly be shown as a reserve. If Mr. Maddisou’s guarantee falls through it could then be used in some way, otherwise it could be used only when the board took over the nurse.

Mr Morse; Is that not the position now ? Mr. Rees: No. It would be optional to the board whether it kept the district nurse going or not. I discussed the whole position with the chief district nurse for New Zealand, and she endorsed the attitude of the board. The board is compelled to keep tho nurse so long as the association finds half of the funds, but when the board has to find funds towards the nurse the position alters. It would then put the association in quite a different position and instead of insisting upon the board keeping the nurse they could merely ask us to do so. Mr. C. Duff: It seems to me that the difficulty is to a great extent with the Audit Department. We have an excellent band of women at Hastings and we must assist them. At the same time, we have to be careful of tags from the Department so as not to render ourselves personally liable for such amounts. The secretary could probably recommend a way in which this amount could be credited to the association. They want the money credited to them That is the real bone of contention. Mr. Morse: At the interview in Hastings when we were making peace (laughter) 1 indicated that the amount was to stand to their credit. Mr. S. J. McKee' What beats me is why the association's funds have to become depleted before it can get this £lOO. Surely there is some moral way by which this money can be paid over. If they can call up the £lOO when their funds are exhausted the money must be owing to them. I do not see why the board should not give the association that credit now. It may be only a “kink” that the Department has which prohibits such a payment but it does seem to be a foolish one. ■ STATUS WOULD ALTER. Mr. Morse: I do not think that the Audit Department comes into it. Mr. Roes: Yes, it does. The condition and status of the association would alter if the board paid over the £lOO. The association was started on condition that there was no cost to the board. If we give this £lOO it becomes a cost. The board would not be obliged to keep the nurse on. Subsequent boards may change their minds about it. I can give you an instance where the services of a nurse were discontinued until the settlers brought the funds into credit again. If the £lOO was paid over it would have to be put back into a reserve again when the funds were built up. Mr. Duff: It is a vicious circle that is making bad relations. Mr. Moise: It is causing much more bother than anything else. Mr. Duff: The secretary should be instructed to place the facts before the Department for instruction. We should also tell the association what we are doing and express the board’s sympathy with them. DRUGS AND DRESSINGS. The discussion then turned to the letter which referred to the charge made for drugs and dressings. Mr. Morse: This £lB 5/10 is stated to be for drugs used for treating outpatients. In here a charge is made and no doubt the nurse is making a charge also. Mr. Rees: No; she receives a donation sometimes. Mr. Morse: If the board has to pay it a charge should be made to cover costs. Mr. McKee: If it is a continuation of the work done at the hospital the board should certainly assist the association Mr Morse: It may be a question whether they are outpatients or not. From returns supplied there appears to be a very small percentage of outpatients being treated. Dr. H. M. Wilson: There is no question about it. There must be a

district nurse for a place like Hastings. If the outpatients pay in Napier it is only fair that in Hastings a similar charge should be made. Mr. McKee: It seems to be a very different position to-day from what it was. The nurse is asked to attend all kinds of cases. If she has to prescribe for a patient the medicine must be obtained from somewhere. Is it the intention of the board to ask the association to pay, or is the board going to shoulder the expense. Who foots the bill if a doctor should order the patient into hospital?—The board does. Mr. Morse: The time has come when something definite should be done. It may be possible to throw the whole of the control on to the association and make them an annual grant. That would save the board a lot of trouble.

Mr. McKee: Dual control is the trouble.

Mr. Rees: That may not work. The Canterbury Hospital Board stopped giving a subsidy because the money was not being wisely spent. It would cost the board about £250 a year. If it got good services 1 would be willing to back it. MR. MORSE APPRECIATIVE. Mr. Morse: It would be a great pity to lose the services of the people of Hastings who are working so hard. I would favour making them a grant and giving them control. Mr. C. H. Williams: Would you pay it to them or put it to their credit on reserve? (Laughter.) Mr. Morse: I think that an interview with Dr. Valintine would overcome the difficulty. He may suggest a satisfactory scheme. Dr. Wilson: If the board makes a grant to the association for dressings it may carry the difficulty over for the time being. Mr. Rees: It would just land the board inlc difficulty. The board cannot make the association any grant whatevei. To show that they were cutpatients treated a record of attendances would have to be made and the whole thing would develop into an outpatients credit which is not desirable.

Mr. McKee: If we had a further conference and the books were produced we might‘find a solution.

Mr. Rees: Out of the 30 cases that the nurse has attended there would be only about five outpatients; the remainder would be patients of the various doctors in Hastings. Dr. Wilson: Could not the drugs and dressings be issued? Mr. Morse: They would still have to be charged up. Mr. Rees: It would be only a book entry but still it would be a debit against the association.

Dr. Wilson: Would not a personal interview get over the difficulty? Mr. Morse: I do not want any mr-e personal interviews. One a year out there will do me! (Laughter.) I think that the whole thing should be put before the Director-General for guidance. I agree that the association should receive some grant for dressings used when treating outpatients. The board then decided that the delegates attending a conference at Palmerston North early next month should confer with the representatives of the Health Department with a view to obtaining some concrete scheme for working the District Nurse Association in Hastings.