HOSPITAL SYSTEM

Hawke's Bay Tribune, Volume XXII, Issue 257, 13 October 1932, Page 7

HOSPITAL SYSTEM

COMMISSION'S CRITICISM BO ABD S' EXECUTIVE’S REPLY, RECOMMENDATIONS ATTACKED. In connection with, the report of the iJational Expenditure Commission criticising hospital administration, the following reply has been made by the Hospital Boards’ Association Executive Committee, for which we are indebted to Mr C. 0. Morse, chairman of the Hawke’s Bay Hospital Board, who is a member of the executive: —

That portion of the report of the National Expenditure Commission which criticises hospital administration offers many points of attack, but it is felt that some of the findings, if made by a special investigation into public hospital affairs after exhaustively sifting the whole of the facts obtainable, would be remarkable.

At the outset the report states: “\Ve have now caret ally considered the vuoie question ox uuspital adnunistratiou, and the cost botn to the Consolidated Fund and by way of local rates. It appears that under the present system of hospital administration substantial relief to the Consolidated f und by way of reduction of subsidy to hospiatl boards must result in increasing the burden of local rates.” Ou the contrary, the present system does not facilitate an increase in levies if subsidies are reduced, for last jear and this year reduction in levies and subsidies went hand-in-hand. In the report, figures are tabulated showing the growth of expenditure on hospitals and charitable aid from £633,607 in 1914t0 £1,930,654 in 1931. No mention is made of the very substantial effected last year. VITAL FACTORS IGNORED. Moreover, this table, through omitting mention of the important factors which account for the increase in expenditure, is surely calculated to mislead. The Commission ascribes the increase almost entirely to the fact that there are too many hospital boards, and ignores the following vital factors:— (1) The trend towards more use of institutional treatment encouraged by improved facilities, improved medical and surgical skill, and an increased confidence in our public hospitals on the part of the public. Better provision for TH. and other chronic cases; development of sanatoria. This trend is the case the whole world over, and no doubt is reflected in improved health conditions. (2) Decrease in purchasing power •f money. In 1929 money had 38 per cent, less purchasing power than in 1914 and 25 per cent, less than in 1916. (3) Charitable aid has increased from 1914 by the startling amount of •ver £200,000 per annum. (4) The very considerable increase in motor and industrial accidentsand the heavy losses in fees occasioned thereby. (5) Improved conditions in hours •f duty of nurses and their remuneration. Also in remuneration of staff generally. (6) The inauguration of a superannuation scheme has cost an additional £19,000 per year. (7) Increase in population of 350,000 persons. Further, it may be mentioned, 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 bo taken into consideration the post-war economic position necessitating many more ' receiving hospital treatment through taxation. Is there a single one of the above factors which would not have operated had the system, as recommended by the Commission, been in operation over those years! . Following the historical review of the ' establishment of hospital districts, the Commission, referring to the different of sanatoria in the North and South Islands, states:—“We see no reason why the sanatoria in the South Island should be maintained partly by local rates and partly by subsidy from the Government, while those in the North Island continue to remain a charge against general taxation.” The Commission does not appear to have been aware—as it should have been—that all patients in the North Island admitted to sanatoria have the payment of their fees undertaken by hospital boards and the fees so paid approximate the cost of maintaining these Institutions. 1 Thus the burden falls equally in the North and South Islands. Moreover, the cost of sanatoria in the South Island as administered by hospital boards has been eased by Government grants. SYSTEM CONBTANTL UNDER REVIEW. It is quite wrong for the Commission to imply that there has been no review of the hospital system since 1909. It lias, in fact, been constantly under review since that time and has been the subject of many enquiries, including the Hospital Commission of 1920, of which Mr Shirtcliffe was a member. The Commission states that the existing powers of the Minister have not served as a check on the ever-growing hospital costs. This merely emphasises the failure of the Commission to appreciate the real causes of this increase. It is pure assumption that the new order of things as recommended by the Commission should have had any greater effect. It has been amply shown that hospital boards have responded to the urge for economy at least as readily as any of the other local bodies. The Commission expresses the opinion that the New Zealand system of hospital finance by way of levy and Government subsidy has resulted in relatively email voluntary contributions being received by hospital boards compared With other countries. It should he pointed ont —as the Commission should know—that eountries Which have relied on voluntary contributions. for example. New South Wales find Victoria, have drifted into p-or’ financier difficultv in financin'* th***--bospital’, ai.d their Governments have

had to come to the rescue. Also the questionable recourse to State lotteries lias been made. REDUCTION OF DISTRICTS. The Commission states that the forty-five hospital districts are no longer warranted and later recommends a reduction to sixteen or eighteen. The Hospital Boards’ Association at the conference in June endorsed the principle of amalgamation through a process of mutual agreement and understanding between the hospital boards themselves.

It might well be asked: Has the Commission attempted to indicate the real factors leading to the subdivision of the hospital districts! It may be remarked that at present the subdivision of a district can only be effected by Act of Parliament. Experience shows that the small district is not necessarily expensively administered while haying a more favourable experience in collection of fees. Nor is the large district the most economical. All that can fairly be said is that, within certain limits, the larger districts tend to facilitate economical administration. This can, perhaps, best be realised if we can visualise one board for the whole Dominion. Surely there ig a point where centralisation must cease to be economical and tend to become expensive.

While drawing attention to the present forty-five 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 the three hundred and thirteen county councils, borough councils and town councils. Surely this is a paradox.

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 the British Medical Association in 1926. They are designed to take over powers at present held by the Minister, the Department of Health and the hospital boards t' selves. The idea was recently de.eloped by Dr. R, Campbell Begg’. AUSTRALIAN SYSTEMS. 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 numbs; of hospitals increased bv 37, and the number of beds by 1,600. The number of in-patients treated increased by 75,000. The inference may therefore be taken that hospitals are not established for political reasons but to meet the needs of the communities which they serve.

The Commission commends the New South Wales and the Victorian systems as a precedent. These are not hospital systems in the proper sense of the word but merely represent an attempt to co-ordinate the work of numerous independent institutions. The position in both these States is not such as to encourage the adoption of their schemes of hospital finance or administrative machinery. The following extract of a letter of 14/9/32 from the secretary, New South Wales Hospitals’ Association, may be quoted:— “I might mention I have taken 'the opportunity of quoting the hospitals in New Zealand as an example of how the hospitals in New South Wales should be financed, and my association is hopeful the day is not very far distant when some tangible form of revenue will be placed at the disposal of the hospitals of this State in the form of a tax.”

As regards New South Wales the desired objective is definitely in the direction of obtaining a system of hospital finance similar to that of New Zealand which, by the way, is the only country in the world which has a fully co-ordinated hospital system with assured finance.

It is interesting to note that under the comparatively recently organised London, County Council hospitals, sixtyeight per cent of the patients are treated as a burden on rates.