BOARD’S PROBLEMS

Hauraki Plains Gazette, Volume 55, Issue 32703, 17 April 1946, Page 5

BOARD’S PROBLEMS

STEADILY RISING COSTS STAFF FOR HOSPITALS REPORT BY THE CHAIRMAN A comprehensive and interesting report on the financial position of the board Was given by the chairman, Mr J. W. Danby at Tuesday’s meeting as follows: — “During the year the raising of the Manpower Emergency Regulations has seriously affected the staffing of the institutions controlled by the board, particularly in so far as the domestic staff of the Thames Hospital are concerned. The Mercury Bay Hospital was closed to inpatients from January 21 owing to shortage of staff. Shortage of staff in all institutions is causing great •concern, particularly in view of the steadily increasing demands for hospital beds. The total number of patients treated during the year was 1960 and the average number of daily occupied beds was 171.25.

"The statement of receipts and payments, discloses that the board commenced the year with a credit balance ■of ' £55771107'4 in the capital account, and a debit balance of £2477/19/2 m the maintenance account, and completed the year with a debit balance -of £252/9/3 in the capital account and £4038/6710 in the maintenance account. Maintenance Receipts "The estimated receipts for the year .excluding levies and subsidy amounted to £&l,700, being made up of fees receipts estimated £31,500, donation £lOO and rents, etc., £lOO. The actual receipts amounting to £37,322718/1 were made up as follows: —Fees £37,050/47'5, donations £ll2/6/0, rents, etc. £1607'7/18. The local authorities levies and refund due from' the Public Account which, together totalled £13751/15711 were paid in full, but the subsidy for the final quarter remained unpaid as at March 31. Subsidy amounting to £l'3Blo/12/0 1 was paid during the year and 1 the amount ■outstanding is £3!865/11/'3. The capital receipts- for the -year were as estimated except that the subsidy for .the final quarter amounting tc £6lB/1072 remains unpaid, and the board received a sum of £32/1070 for the sale for removal of Jacksons cottage which was not estimated. Maintenance Expenditure "The total estimated maintenance expenditure for the year amounted to £03,127/1972. and the actual expenditure totalled £68,92472710. The estimated expenditure for all institutions amounted to £55,050- and the amount actually spent was. £61,349/ 14/6. .General expenditure was estimated. at £5.10'0 and the actual expenditure wasi £5,0967972. Details of maintenance expenditure will be dealt with later in my report. The estimated capital expenditure was- £6,000 and the actual expenditure was- £5,666/9/1 made up as follows:—Thames Hospital land, buildings and equipment £4799/167'7, Nurses Home furniture £36/112/6, Paeroa Hospital buildings £4OO/070, Motor truck £4BO. Maintenance Receipts

“The estimated receipts and expenditure for 1946-47 is as follows:—The

total estimated maintenance receipts from all sources (excluding levy and subsidy for the current year) for the ensuing year amount to £301865/11 / 3 compared! with last year’s estimated £33,9618/7/9' and actual £37,-322/18/1. The various items of revenue are as follows:—Refund Public Account, nil, last year, £33/0/2; subsidy outstanding 31-3-4'6, £3,865711/3, last year £2,1213577/7; fees recoveries, £35,000, last year, £311,000; home recoveries, £B'oo, last year £500; donations, £lO9, last year £100; rents, etc., £lOO, last year, £lOO. “The difference between the estimated amount of receipts for this year as compared with last year viz: £5,897/3/6 is due to a higher estimation of fees receipts' and the fact that the amount of subsidy outstanding as at March 81 is greater than at the same time last year. I fear that we are being slightly over optimistic in the amount of estimated fees receipts for, although they are less than the amount actually received during the p'ast year, viz: £3'7,05074/5' the reason for the increased amount received during the year compared with the estimated amount was that the monthly claim for hospital benefits for February which has never yet been paid to early in April, was l paid this year in Mhrch meeting that the board actually received payment for 13' months fees in the financial year, and this cannot occur in the coming year. The amount estimated to be received from homes inmates is also higher owing to the monthly payment from each inmate being icreased to £5/1276 from £5 and the fact that there are more inmates in the institution. Maintenance Expenditure “Thames Hospital: The total 'estimated expenditure for 1944-45 was £34,600 and the amount actually spent was £38,48473/8. The amount estimated! for 1940-47 is £41,000. Details of this expenditure follow: — “'(1) iSalaries and wages estimated 1945-46 £lB,OOO. Actual £21,11276/7 estimated 1946-47 £22,500. This item requires very little if any explanation. The retrospective increases granted by every award as well as the new schedule of nurses salaries caused approximately £3,000 of the increase of expenditure over estimate. This was unavoidable and completely outside the power of the board to control. Furthermore, those increases brought in their train the reconsideration of the salaries of the heads of various departments who in some cases were receiving less than their subordinates. These increases have applied to the present staff which is very much short of requirements and if possible more nurses and domestics will be employed. Furthermore, the board is now employing a dispenser and a laundry manager whose salaries total another £BOO, so provision has had to be made in this year’s estimates of £1,388 over last year’s actual expenditure to provide the necessary amount under this heading. “(2) Provision estimated l 1945-46 £5,000; actual £6,012/1/2; estimated 194'6-4'7 £6,500. Exorbitant Prices “Various have contributed to the increase of £1,012 of actual over estimated expenditure ' under this, heading. Milk which cost £531 in 7944-45 cost £7OB last year, an increase of £177 due to the dry season. Vegetables which

cost £650 in 1944-45 last year cost £829, an increase of £179, due chiefly to the exorbitant prices of vegetables ruling for the greater part of the period. Meat which cost £B4O in 1944-45 last year cost £940, an increase of £lOO. Groceries which cost £1,740 in 194445 cost £2200 last year, an increase of £460. The other £lOO was caused by an increase in the price of fish and the fact that considerable quantities of tonics are now being supplied daily to T.B. patients. Provision has had to be made this year for a further £5OO due to the tenders for provision all showing increases and also that provision has been made for an increase in the number of occupied beds now that the additional accommodation in isolation is ready for use.

t '‘ l (l3) Domestic estimated 1945-46 £5,000; actual £5,592/12/2; estimated 1946-47 £6OOO. The iricrease of £592 of actual over estimated expenditure wa& due to numerous causes. The provision of extra beds for the church hall for use as a scarlet fever ward and extra bedding accounted for over £2OO of this increase. The amount paid to the borough council for electricity, etc., was £958 last year compared with £8413 in the previous year, an increase of £ll5. Renovations to nurses home and house surgeon’s furniture has cost another £lOO. The amount provided for the current year has been increased by £4OO to £6009 to provide for a large consignment of crockery, (the first for four years) which we are advised, has left England.

Saving In Dispensing

“(4) Establishment — estimated >194'5-46 £2,000; actual £2,090/14/9; estimated 1946-47 £2,000. These figures call for no comment.

“(s)' Surgery and Dispensary— Estimated. 1945-46 £4,500; actual £3,6707'2/1'1; estimated 1946-47 £4,000. The reduction in the actual expenditure for the year compared with the estimated is very gratifying and reflects credit on the administration of thia department by the dispenser. At the half yearly period ending September 30, 1945, the actual expenditure was £2,176 or very nearly the amount of the proportion on the estimated figures. The dispenser was appointed at the beginning of October and the expenditure since that date was £1,500. The main reasons for the reduction were that a very clo-se check has been kept on the stock position and the more expert compounding of stock mixtures and prescriptions with resultant obviating of a lot of unnecessary expense and’ waste. In providing £4,060 for the current year, this figure was arrived at as the* medium between the estimated and actual expenditure and in view of the fact that the policy of the new medical superintendent regarding medical supplies is an unknown quantity, it is considered. that it is better to estimate at this figure and be on the safe side. “'(6) Grounds. —'Estimated! 1945-46 £100; actual £6/5/0; estimate 1946-47 £lOO. * Other Institutions “District Homes: The total estimated for the year was £lO5O and the amount actually spent £1,067/3/6. £1,150 has been provided for next year The whole of this increase is under the items of provisions and the reasons—& greater number of Jnmates and higher costs. “Waihi Hospital: The estimated expenditure for Waihi hospital was £10,600' and the amount actually spent £12324/13/I'l. The estimated expenditure for 194'6-47 is £14,'3'50. Details are as under: — “(1) Salaries and Wages—estimated 1945-46 £5,750. Actual £7,57271/7; estimated 1946-47 £8,750.

The excess of actual over estimated expenditure of £1,822 was due chiefly to general increases in salaries which as stated before was out of the board’s hands. The appointment of an engineer, the authorised increase in the medical superintendent’s salary, precision for increases due under the nurses’ salary scale and provision for extra staff needed to fill vacanices make it necessary to provide an extra £1,200 for the ensuing year. Provisions At Waihi “(2) Provision. — Estimated 1945-46 £1750; actual £2155/11/6; estimated 1946-47 £2,250. The reasons for the increase of £405 of actual over estimated expenditure were many. Meat foi instance cost £430 compaied with £313 last year, an increase of £ll7 and due almost entirely to the higher prices on the contractor’s schedule. Vegetables were £lOO higher at £350 compared with £l5O last year. Groceries were

£2OO higher at £BOO comparetl with £6OO last year. Increases in the contractors schedules for this year have made it necessary for the estimate for the coming year to be raised by £lOO to £2,250. “(3) Domestic.—Estimated' 1945-46 £1,250. Actual £1,579/1/7. Estimated 194'6-47 £1,500. The renewal of was the main factor contributing to the increase under this heading. The coming year’s estimate of £1,50'0 provides- for further replacements of linen and crockery.

“>(4) Establishment. — Estimated 1945-4'6' £750. Actual £463/7/0. Estimated 194'6-47 £l,OOO.

“The painting of the exterior of the hospital which was not done last year is provided for in the current year’s estimates and' also the improvements mooted for the kitchen and steam services.

“(5) Surgery and' Dispensary.—Estimated 1945-46 £BOO. Actual £BO9/19/9. 'Estimated 1945-47, £BOO. These figures’ require no comments'. f<l (6 : ) Grounds.—Estimated 1945-46 £3OO. Actual £244/1276. Estimated 1946-47 £5O. The actual expenditure was less than estimated'. In the coming year the salary of the gardener has been included with salaries and wages.

Hospital At Paeroa

“Paeroa Hospital: The total estimated was £1,900, actually spent £2,166719/10 and estimated' for the ensuing year £2,500. “(1) Salaries and Wages.—Estimated 1945-46 £1,150; actual £1,432/6/9; estimated 1'94’6-47 £1,6'50. This increase was due to the same cause as at other hospitals. Owing to lack of non trained staff and! authority' being 'given to employ trained nurses in their place, provision has had to be made for the increased cost in the coming year.

“(2) .Provisions.—Elstimated- 194546 £3'oo; actual £36'5/6/10; estimated 194’3-47 £350. The cause of the increases at this' institution was substantially the same as that at the other hospitals. ‘“(3) Domestic.—Estimated 1945-46 £250; actual £257/19/1; estimated 1946-47’ £250. These figures require no comment.

“(4) Establishment.— Estimated 1945-46 £5O; actual' £47*/13/0; estimated 1946-47 £lOO. The estimate and actual expenditure for last year were approximately the same and l require no comment. For the ensuing year provision is made to repair diamage caused: to plaster walls by leaking roofs. “'(5) Surgery and Dispensary.—. Estimated 1945-46 £100'; actual £59/13/5; estimated 1946-47 £lOO. These figures require no comment. .“(6)' Ground.—Estimated 1945-46 £5O; actual £4/07'9; estimated 1946-47 £5O. Coromandel Hospital “Coromandel Hospital: The total estimated, expenditure for the year was £5,'5*00, the actual was £5,310/15/4 and) the amount estimated for 1946-47 is. £5,650. “(1) Salaries and Wages estimated 1945- £3,200; actual £3,013/17/3: estimated 1'946-47 £3,025. This institution has been understaffed for many years, chiefly due as at Mercury Bay, to its 'locality. The result is that although the board estimated for a complete staff the amount provided was not expended!. The sum' provided for this year is approximately the same as providled for last year in the hope that some relief can be granted. Provisions. —Estimated 19-15-46 JESOiO; actual £B'B3/0/11; estimated 1946- £9OO. The cause of thp increases at this institution are the same as noted under- this heading for the other hospitals. “■('3) Domestic.—Estimated 194'5-46 £700; actual £742/13/3; estimated 1946-47 £7'so. These figures 1 require no comment. 4 Lighting Plant “(4) Establishment.— Estimated 1945-46 £300; actual £389/1271; estimated 1'946-47 £3OO. The reason for increased actual over estimated expenditure under this heading was that the batteries in the lighting plant broke down and had to be sent away for repairing and casing. The amount provided for next year is the same as was provided last year. “(5) Surgery and Dispensary.—Estimated 194'5-46 £400; actual £25'9/'l4 /7; estimated 194'6-47 £49!) The actual expenditure appears lower than estimated because the sum of £163/19/4 was received- from Pharmaceutical benefits has been credited against this item. The actual cash expenditure for drug's, etc., at this hospital was- £42371'8/11 and provision has teen made for £4OO for the ensu-

ing year. ■ “(6) Grounds. —Estimated; 1945-46 £100; actual £l'6/17/3; estimated 1946-47 £5O. This, item requires no comment except that if satisfactory arrangements can be made the rest of

I the hospital drive will be tar sealed. I No provision has been mad'e for this, i Bay Hospital - "Mercury Bay Hospital: The total estimated! was £1,900 the amount actually spent was £1,495718/3 and the estimate for the ensuing year is £1,850. 'Lack of staff has caused the board to temporarily close this institution since January 1 and this is the reason for the discrepance between actual and estimated expenditure for last year. With the institution also closed for part of the. ensuing year, the sum provided l should be sufficient for requirements. “The total amount allowed above for institutional expenditure for 1946-47 is £66,600 which is £11,050 more than last year’s estimate and £5,250/5/6 over the actual expenditure. General Expenditure “The total provided for these items viz: £6,400 together with the debit balance of £4,038 /16710 carried forward and including the sum of £9B'9/3/8 to be refun died to the Public Account, makes a total of £11,4218/074 which is £3,850/1/2 more than last year. The debit balance is £1560717/8 higher than last year and the refund to the Public Account is an item which did not have to be provided for in last year’s estimates'. Administration Costs “Administration is estimated at £2250, which is £250- more than estimated for last year when the actual expenditure was £183374/9. This will ■be required to meet the higher cost of salaries in the office. Interest on overdraft is highei’ by £5O than last year’s estimate. The amount paid during the year was £11673/9 and caused by the board’s account being . overdrawn for the whole of the year. The item public health disappears and in its place truck expenses is inserted for the same amount.

“National Provident Fund contributions are estimated' at £650 which is the same asi last year. The net cost to the board 1 last year was only £49/072, but this was due to the fact that large refunds were received owing to nurses withdrawing their contributions.

“Fees payable to other boards is estimated at £2500, compared l with £lsoo' estimated last year and £2091/277 actually spent. The board has no control over this expenditure and the only chance of reimbursement is to obtain, the consent of the Department of Health and Price Tribunal to increases in the rate of daily fees charges to other board's.

“Charitable Aid is estimated 1 at £lOO which is the same estimated for last year and l this applies to the other items, St. John Ambulance, subsidy and miscellaneous expenditure. Proposed New Works

‘^Capital.—The proposed new works for next year were discussed and approved! by the board at the March meeting, and provided for £3380 which together with the incompleted existing contracts and l the debit balance, carried forward total £5622/9/ ( 3. The only estimated receipt is outstanding subsidy £616710/2, which leaves a net estimated expenditure on, capital works of £5003/1971.

“Levy and Subsidy.—The estimated maintenance expenditure of the board totals £78,028/0/6, and the estimated receipts as stated before amount to £39,865/11/3, leaving a net estimated maintenance expenditure of £38,162/9/3.. In accordance with the provision of the fourth schedule of the Act, this amount is apportioned between the local authorities and Department of Health as under t- — Local authorities £17,820/9/3; Department of Health £20,342/-/-. The net estimated capital expenditure as mentioned previously is £5003/19/1, which is apportioned equally between the local authorities and Department of Health:— Local authorities £2501/19/6, Department of Health £2501/19/7. Levy on Local Bodies. “The total amount to be levied on the local authorities is £20,322'48/9. From this must be deducted the special contribution from the Waihi Borough Council of 10 pei- cent, of ths gold revenue receipts for the year ending March 31, 1946, viz, £2842/111/3 or £284/5/2, leaving an amount of £20,028/'3/7 to be met by a levy on the rateable capital value of the hospital district. For the purpose of the levy the R-.C.V. is £6,643,522 and to produce the required amount a levy’ of approximately .72'4d. in the £ is required. “The subsidy on maintenance levies is 227’10' per £ and on capital levies is 207 - per £. “The levy for this year is a record in the board’s administration but is unavoidable and I pubr licly intimated two months ago that a 25 per cent, ificrease in this

year’s levy was inevitable The actual increase is 25.5 per cent, over last year, and unless the Government brings in legislation to implement recommendation in the report of the Select Committee on Local Government to stabilise levies on the basis of the 1935-39 average the board’s demands on the local authorities, must inevitably increase, particularly in view •tf its large projected capital expenditure on the Thames Hospital rebuilding scheme. The increase this year is in keeping with the general trend in other parts of the Dominion, because the causes are universal and not confined to any one particular district although they naturally fall harder on those boards whose size is

greater in proportion to its rateable capital value than in other more favourable hospital districts. For instance, it seems anomalous to me that the Cook Hospital Board, which is the next largest board in the Dominion to ours, can receive more than double the contributions from its contributing local authorities by striking the same jrate of levy in the £ of R.C.V. as this board. This board is the thirteenth largest in size—that is according to its daily average occupied bed rate—but is only twenty-first in order of wealth in terms of rateable capital value. The cost of maintaining the institutions is rising but as I have said, this is unavoidable, and I would state that the service being rendered to the sick is unexcelled in any part of the Dominion.