CARING FOR THE SICK.

Horowhenua Chronicle, 29 April 1931, Page 7

CARING FOR THE SICK.

CONTROL OF PALMERSTON

HOSPITAL.

description of past ACTIVITIES AND PRESENT ECONOMIES.

ADDRESS BY MR CK A MONK.

Following upon the; decision of -the Palmerston North Hospital Board, at a special meeting recent- - ly, to reduce the levies on the contributing local authorities by 10 per •cent., an interesting survey of the general position of the Board’s enterprises was given on Wednesday sentative of the combined boroughs •of the Horowhenua district, in addressing the meeting called Jin the Century Hall by the Mayor (Mr C. Blehkhom) in connection with the municipal .election.

WHY COSTS HAVE RISEN,

After thanking the Mayor for having him this opportunity to speak to the public of Levin, Mr Monk said that when one heard about the climbing costs of boroughs or county the position was generally attributed to the Hospital Board. The costa of hospital upkeep -„had risen throughout New Zealand, and this was probably because medical sci- , once had progressed and expenditure had to keep pace with it and thus defeat the undertaker, and the cemetery. the 10 years during which he had been a member of the Palmerston N. Board, that body had made extensive alterations and extensions to the

hospital. The time for them had been ‘-due, because all through that period the hospital 'had been over-full. It had been hoped to have some extra ae■commodation this year, but the patients from the Hawke’s Bay earthquake area had over-filled it. Although the Board '-had had to call a halt owing, to the -depression, extensions in the past had •heen justified. LEVIES AND SUBSIDIES.

There had been some criticism in the past, Mr Monk continued, to the effect --that hospital boards had been extravagant for the reason that they did not have to appeal to the ratepayers for money, but only had to ask and receive it. He was at one time a member of the Wellington Board and since 'then had been on tfie Palmerston Boar,d nnd his experience was -that the object of every member of this Board had been to keep down costs -and at the :same time ensure the efficiency that *"-was necessary to relieve the sick. A sick person was a burden on the community. The method of finance for a hospital board was that it made levies —on the local bodies, and that the Government paid a subsidy on the basis of £1 for £1 on the levies collected in the Dominion as a whole. This meant m piat in many cases the subsidy was much below £l, while in districts that ■were not wealthy it often rose above £l. In addition there were voluntary contributions to the hospitals, and the boards collected a certain amount in patients’ payments. To give some idea of the enormous business covered by a hospital board, -Mr Monk stated that the maintenance levy that was made last year in the Palmerston Board’s district was £22,276. This year it was proposed to „levy £19,826. The maintenance subsidy last year was £18,137, and for this jear. it was estimated at £14,536, which meant that the Board would receive 14s 8d from the Government for every collected from the local bodies. FAVOURABLE COMPARISON OF MAINTENANCE. In introducing some comparisons of hospital maintenance costs, Mr Monk * said that-the affairs of the Palmerston Board were run as reasonably as those <of any hospital board in the Dominion He gave the following statement of "the Palmerston North hospital and those nearly approximating it in size:

, ti o ® 05 • *■£> o> P r& ® c 3 N H PhOI m A h rH *H ® S ® m ® _, ■ « ft.H - 5 U . CL ® r O n jj h +j "*Z g *3 g § g $ j cm ® O c, O *. <1 O & O O O -fa £ £ Palmerston N. 173.4 180.6 10.8 -Punedin .. ~ 248 223.7 12.2 • Napier 195 213 11.4 New Plymouth 155.3 202 15.2 "Wanganui . .. 132.2 189 11.6 Gisborne .. .. 132.2 199 13.4 He claimed, therefore, that th e cost jper occupied bed at Palmerston was T6&SOHcll}l6 OF PATIENTS' FEES. With respect to the question which was often discussed by local bodies, the collection of patients' fees, this -was a very difficult matter, particularly when times were as at present. During the past five years the Palmerston Board had collected the following .amounts in patients' fees: — £ 1926- 7,256 1927- 7,805 1928- 10,138 1929- 11.643 1930- 11,024 It was estimated that £14,000 would lae collected in the current year. The treason for this larger amount was that it was expected that there would be :2k greater number of occupied beds, also ' that, as the institution had been treating a considerable number of patients from Hawke's Bay, it would be paid over £IOOO by the board of that district v Personally he thought that the set was « '" + le high. SACRIFICE BY THE STAFF. Coming to the question of how the levy for-the current year had been reduced, Mr Monk said he was sorry to 'atate that a considerable portion of the .amount had been taken from the staff. "The 10 per cent, cut had gone clean through the institution —except as to first-year nurses —and this with staff productions, was to produce £3OOO. The had had the staff with it in this ' matter. It was regretted that such a ; -course had had to be taken, but the •Government had passed the 10 per cent. ~ -cuton to the hospital boards, i The subsidy from the Health Department would ; : also be cut 10 per cent, this year. The paid a tribute to the very fine 'by.,,the■ managing secretary

(Mr A. J. Phillipps) in preparing the report for the general meeting. The manner in which he had searched every avenue in respect to making reductions reflected credit on him. Praise was also due in this connection to the staff and the chairman of the Board (Mr J. K. Hornblow). RETURN PER BED. *

Mr Monk quoted the following figures showing the" relation of fees collected to the occupied beds: —

1931-32 (Estimate) ~ 210 66 GUARDING AGAINST RELAPSES. A good deal had been said, Mr Monk continued, regarding the cost per occupied bed, and there was a movement in Wellington, headed by Mr Campbell Begg, surgeon, based on the that patients were kept too long in hospital and that in many cases they could be discharged earlier. The experience at Palmerston was that, if they were discharged at too early a date, they came back. What had to be arrived at was a stage when they could go out without there being any fear of their coming back. He thought that there was a danger in trying to cut down the time a patient was in hospital. It should be seen to that they were well enough to ensure that there was no danger of their reutrning. • BOARDING EXPENSES.

Another matter was the cost of provisions per head for the patients and staff boarded. Mr Monk gave the following comparative returns, for the year ended March 31st, 1930: £ Dunedin 25.5 Napier 24.9 Palmerston N 22.1 New Plymouth .. . .. 25.8 Wanganui .. 21.2 Gisborne 33.7 “The reason why there is one Board below us,’’ said Mr Monk, “is that we give a hot meal in the evening and they dont. ’ ’ BURDEN OF CHARITABLE AID. The Board had been caused grave concern during the past year by the great increase in the charitable aid that had had to be distributed. A very big industry that was in full swing a year or two ago, the flaxmilling, had since ceased, and it had cast on the Board’s hands a number of families who -were in want. While the estimate last year for charitable aid was £4300, the actual payments amounted to £5358. The estimate for the current year was £SOOO. Unemployment was the main cause of the trouble, and 254 families had on this account to be aided last year.. The Hospital Board had hoped that, with the Unemployment Board’s scheme, the whole of the charitable aid on' this score would be wiped out, but so far that had not been realised. He did not think it had been intended, when the Act was framed, that the hospital boards should have to care for people who were out of work. This matter appeared to be a national obligation, but the Board had had to shoulder the brunt of it and do the best it could. RETARDING OF CAPITAL OUTLAY The capital estimates this year had been reduced as far as possible. The nurses’ hom e had been completed and the new theatre was about to be completed. These buildings were part of a scheme formulated in 1918. It was decided last year that, with the furnishing of th e nurses’ home and the building of the new theatre, no further loan money be spent on capital work till times improve. The erection of an administration block in the scheme would be held over in the meantime. OTAKI HOSPITAL. Speaking of the Otaki hospital, Mr Monk stated that it was opened nearly two years ago as a general and maternity hospital. After eighteen months it was found that the use was not being made that should have been made of it; it was thus becoming very costly, the Board not getting the return it should from it. At present it was on trial as a maternity hospital alone. Arrangements had been made with the medical practitioner, at Otaki to take any urgent cases into his own hospital before sending them on to Palmerston. Mr Monk thought that the Otaki hospital had been used quite a good deal more as 'a maternity hospital. The Board would save about £I2OO a year on the maintenance of this institution, the staff having been considerably reduced. AMBULANCE ARRANGEMENTS. Concerning the question of ambulances, Mr Monk said it was formerly decided that an ambulance should be stationed at Otaki. However, when a new ambulance had been landed and a body built, the number of runs to Otaki certainly did not justify a £7OO or £BOO vehicle being stationed there and a man being kept to run the ambulance when called on. The Board reduced the ambulance fees from the district, and both ambulances were now stationed at Palmerston, which was about an hour and a-half from Otaki.. If one of the ambulances broke down, the other was on the spot at Palmerston. The Board had considered the ambulance fees too heavy and had decided to make two charges—one of 10s, to operate in a four-mile radius, and the other of £l, for the outside districts. Previously it cost about £3 10s to take a patient from Otaki. SAVINGS ON LEVIES. The savings to local bodies in this district that would be effected by the Board’s reduced costs of administration were:— £ Horowhenua County .... 628 Shannon Borough .. .. 19 Levin Borough 50 Otaki Borough 24 LIMITS OF ECONOMY. The Board had gone very carefully into the question of making further

savings, but this was quite impossible unless one of the wards was closed. Auckland was being forced into that position, but the Palmerston Board hoped that it would not be under a similar necessity. The hospital was there for the benefit of the people in this district, and the Board hoped to b e able to keep it open; but if forced by the Government to make any further cut, the only course was for it to restrict the number of patients that could be taken. OLD PEOPLE’S HOME. The Board administered the Old People’s Home at Awapuni, which institution carried between 40 and 50 inmates. It was not self-sppporting, by any means, but it was quite a good institution and the old people in it were very happy and were being well cared for. HOSPITAL FARM. There was also run in connection with the hospital a farm, and the Board had been told that it was a sort of hobby. It was not altogether a hobby; it served a real, useful purpose, and was also saving the Board a fair sum -of money each year. In the purchase of these farms, only half the money was found by the ratepayers, while the other portion was provided by the Health Department; but, taking into consideration all costs and allowing interest on the money invested, the farm had for the past two years made a profit of over £250 and had supplied the milk to the hospital at a flat rate of Is per gallon. The farm produced a certain amount of vegetables and bacon, and all these products were credited to it. The hospital had, at times during the winter, experienced very great difficulty in getting milk, but now it was assured of a supply of good milk from cows that had been put under test, and that had made the farm worth while. RATEPAYERS’ INTERESTS WATCHED.

“We have to have hospitals,” sai4 Mr Monk, in conclusion, “and my experience is that, generally speaking, the members of a hospital board very carefully watch the ratepayers’ interests. Everything possible is done to keep down costs. We have done that in Palmerston North. It has been my experience that practically every person who goes into hospital has a grouch, but we expect that from a sick person. ’ ’ On the motion of the Mayor, a hearty vote of thanks was passed by acclamation to Mr Monk for his able and interesting address.

O CO o . Ijs rrt o T? 0> <y _Q 05 fcH) 05 ' g ft ’ S p» > w < o O Q} CL? P* 00 53 o 5 o fc o Year. £ £ 1923-24 .. .. .. .. 102 29 1924-25 .. .. .. .. 124 44 1025-26 .. .. .. .. 131 54 1926-27 .. .. .. .. 127 53.7 1927-28 .. .. .. .. 163 44.4 1928-29 .. .. .. .. 188 51.2 1929-30 .. .. 181 60.7 1930-31 .. .. .. .. 201 50.3