Hospital Administration Again Under Fire

Manawatu Times, Volume LIII, Issue 6616, 22 May 1928, Page 8

Hospital Administration Again Under Fire

Demand For Complete Overhaul of System

Borough Council Asks For Royal Commission

Another broadside was launched at hospital administration and policy in general and the Palmerston North Hospital Board in particular at the meeting of the Borough Council last evening, Councillors M. A. Eliott and A. E. Hansford supplying most of the ammunition.

As an outcome of the discussion, Councillor Eliott’s motion asking for a commission was carried, and a deputation is to wait on the Minister of Health when he is in Palmerston North next week.

Cr. Eliott’s motion, of which notice lad already been given read: That owing to the heavy expenditure in the near future proposed by the Palmerston. North Hospital Board and in view of the belief that the honorary medical staff and many other responsible persons are of the opinion that a great deal of this proposed expenditure is unnecessary and wasteful, the Government be requested to appoint an independent commission to enquire into the whole position and to take ail jieccssary evidence. That tho Government be asked to (1) restrain tho Hospital Board from starting building operations until tho finding of the commission is available; (2) in the event of tho verdict being against the Board then to stop the expenditure altogether. That all tho local bodies on whom the Hospital Board levy a rate be asked to support this request by communicating with tho Government. That Messrs. Nash, Linklatcr, G. Eliott- and Eiold, M’s.P., bo asked to support *tlio request.

In moving his motion Cr. Eliott s fil'd '• “Tho total estimated capital expend!-, turc by tho Palmerston North Hospital Board for 1927/28 is £36,697. The principal item is for the erection of a now two-storev block of buildings estimated ; to cost £IB,OOO and it is proposed to call tenders for this job at once. “The object of my motion is to endeavour to stop the acceptance of any tender until an independent commission can give its decision as to whether this building and other items of capital expenditure are necessary or not.

“Surely if tlic statements made by (lie memusrs of tlio Board arc correct, tliey have nothing to fear from investigation and should welcome the commission with open arms, and on the • other hand, the local bodies on whom the increasing burden of Hospital Board rates has become such a serious, matter, arc entitled to know front an independent source if the proposed expenditure, taking all facts into consideration, is justified or not. “The opinion of the honorary medical staff must surely be taken into very serious consideration. They are in very close touch with the management and requirements of the hospital cud if many of them affirm emphatically that this huge building programme is not justified then surely the position requires searching investigation. “The reason given by the Board for the large capital expenditure is the in crease in the number of patients. Whether this increase justifies the expenditure or not is a matter for investigation, but undoubtedly so long as persons who can well afford to pay arc admitted to the hospital and given free medical attendance being merely charged with a small maintenance fee which does not cover any interest on capital expenditure, then more buildings and still more buildings and further capital expenditure within the near future will bo wanted. “A fee of £3 3s per week is charged by the Hospital Board to those patients who arc able to pay. In computing this nmount, no allowance is made for overhead charges or interest and sinking fund on capital expenditure, or for dopreciation of building, plant, etc. If the actual cost was charged it would do nearer £6 6s per week and even this would ho giving in free medical attendance. “Why should the ratepayers be called upon to find in hard cash about 50 per cent, of the actual cost of the maintenance of patients who can well Bfford to pay the -whole cost? “The -whole matter of hospital expenditure has become a scandal and the sooner legislation Is introduced to put some check on it the sooner will the ratepayers obtain some relief from the burden of ever-increasing hospital rates. The hospital should he for the poor and indigent and no one else. “The following are the total levies collected from local bodies during the years 1923 to 1925 — '1923 £13,913 1926 £16,733 1921 £13,950 1927 £17,600 1923 £13,522 1928 £21,503 “It will bo seen that in 1923/21 and /25 the levies were about the same, why then the orgy of expenditure showing an increase of 50 per cent oc necessary only three years later? The population has increased by only S.l per cent, during that time. “In the reply by the Board to our protert they endeavour to make a strong point of the fact that Palmerston N .rth receives the greatest benefit from the Board’s expenditure, 16 per cent, of cxpndituro for 20 per cent, of levy. The inference is that the Palmerston North Borough Council should therefore ho the last, of the local bodies to complain. This is a very narrowminded and parochial view to take and if carried to its logical conclusion it

would mean, that so long as public expenditure (.however wasteful and extravagant) was being made in some favoured locality, tho local body in that place should sink its independence and allow this waste without protest I cannot believo that these ethics would find favour with many local bod.es in New Zealand.

“Tho secretary of tho Board has quoted “exhaustive statistics’’ to show that tho cost per bed of the Palmerston North Hospital is lower than in some other hospitals. Is this a criterion of efficiency when all pul'lie hospi.als arc spending amazing sums on maintenance alone. The secretary of the Board will find it hard to convince tho contr bating bodies and bo will not find them as docile and easy to lead as apparently tho members of the Hospital Board arc. This year the cost of administraiion is £2350. It Mould bo interesting to know what this item was, say, four years ago.

“One looks in vain for some protest from the Palmerston North representatives when the Hospital Board’s proposals to spend £36,697 were made, blit, apparently not only was no protest made hut they supported the proposals. Mr. Nash's remark that tho ‘members of the Palmerston North Borough Council needed enlightenment’’ - •? --.ito uncalled for. The Borough Council and the ratepayers of Palmerston North fortunately do not need “°nlightenment” from Mr. Nash on hospital expenditure. Crushing Burden of Cost. Cr. A. E. Hansford, in the course of bis remarks said: “In quoting my figures before the Council a fortnight ago 1 used mostly Now-Zealand figures to show tiro increasing cost, of administration of our hospitals to tho people of New Zealand and I feci suro_ if the admissions and costs increase in. the future as they have in tho past it will only be a matter of a few years when the whole system will crush with fho burden of its own weight. Let mo read to you what the' Director-General of Health said in 1925 “The increasing burden of hospital and charitable relief ,upon the ratepayers and the Consolidated Fund is of cour.-o a matter for concern, even if such amounts have been wisely and necessarily expended, ano as a natural sequence the Department has examined v arious suggested methods for relieving the burden. So far, however, no method has boon do vised which possesses features superior to tho present method of meeting the deficit by an equal burden on tho local rates and the Consolidated Fund. .“As a matter of fact, though it ihust bo expected that there will always bd a slight increase in.-our hospital expenditure, yet ns the health of tho people tends to improve as a result of preventive medicine and the better understanding and practice of Hie laws of hyg'eno, the cost of hospitals should tend to decrease in comparison with tho incrca'o in the population. The advance made during recent years in medical sci cnee, however, and tho consequent necessity for modern equipment anti special. departments has prevented any appreciable diminution in the increase of expenditure.’’ But notwiths’anding what the Dircc tor-Gcnoral said about improved health in 1925 the costs aro still steadily going up right through tho Dominion. Further on in the same report ho says. “Tho fact remains, however, thai the average cost of our hospitals, in eluding all overhead charges, is bo tween 15s and £1 per diem, and ot

the 9s per diem charged by the majority of the Boards under -is per 'diem is collected. A considerable amount can still be done in the direction of educating the people to recognise their obligations in regard to tiioir hospital accounts. There are still people to bo found who consider that because they are ratepayers they should bo entitled to free treatment. ”

“1 say, continued Cr. Mansford, a system such as this is wrong and will •defeat the very intention of what om public hospitals wove originally intended for, namely the treatment of those who cannot afford to pay. ft: wo are going to admit anyone that wants admission then they must at least pay the cost, not £3 O.s when it costs say £7 7s to say nothing of the nnfa'r position (He honorary medical staff are being put in. As I said before the whole system will crash unless put on a more business-like footing. Comparisons are Odious. “I also quoted comparisons of the Wanganui and Palmerston North Hos pifals for the year ended March 31 1927. For doing this I seem tn have brought down the wrath of (ho Board upon my head. “I took the unit cost as used by the

Government Statistician in the official I'car Book and on the unit system my figures are correct.’ Now the secretary, in his report, goes into devious ways and means to prove that tho unit system is unfair. I agree with him that surgery and dispensary should bo spread over tho patients treated and in this both institutions arc equal. If we subtract this item from tho tolal cost of each institution we are faced with tho hard fact that Wanganui maintained a daily average of occupied beds of 1311,3 at a cost of £22,220 or a cost of £139.9 per occupied bed. Palmerston North maintained a daily average of 127.1 at a rost of £20,798, or an average cost of £163.6. It is the cost of treating sick people that we are getting at and not the cost of maintaining established emptv beds. “If Palmerston North has an established accommodation of 20-1 beds and has a- daily average ,of only 127. whereas Wanganui has established bods to tho number of 181, and has a daily average of 139, then I say just so far is the Wanganui Hospital better managed than ours. Probably Wa.nganu: adopts a waiting list sy'tcm for nonurgent cases and I understand Jhcv have not adopted this system here. “However, if Palmerston ?Corth has regained its position at March 31. 1928. as far as Wanganui is concerned, then 1 will bo one of the first to congratulate the chairman and members of the Board on their achievement. “ Now I come to Mr. Nash. Ho is reported as having said: *1 Gunk a copy of Mr. Phillipps’ report should bo sent to tuc Boroug.i Council, is, migut enlighten them.’ Now tho sting oi that remark is contained in the word might! Personally 1 take the icmarlt as an imm.l to our intelligence.

“As regards tnc secretary, Mr. PLillipps. Ho quotes-.figures showing where the patients c0,..e from, etc. This to my. mind is setting town against country and it is a regrettable attitude to take up. If the system of collecting levies is wrong then by all moans let it bo remedied out there is another side to this question and for me to cn.arge upon it would oniy make tho position town versus country worse and I am not out for that sort of thing. “Tho" secretary states in his report that I' only made a half statement when saying the levy in Palmerston North had increased by 298 per cent, since 1917. He brings in revaluations, etc. Well, if he gets any satisfaction .out of that position ho is entitled to it, but I still say flic Borough Council levy in 1916/17 was £IOSB and 1927/28 £4209.

“The secretary then elaborates what ho considers a more correct system iwhich, shortly, amounts to this, that the items surgery and dispensary should be taken over the whole patients treated and tho balance of the items spread as between occupied bods .and established beds.

“Now, this is tho very admission 1 wanted. lu his report dated the 31st March, 1927, ho compares Palmerston North, Hamilton, Napier and Wanganui ter the year 1920 and ho takes the w’holo cost, including surgery, dispensary, provisions, domestic establishment, salaries and wages, miscellaneous etc., and divides this total by tho number of patients treated which docs not .show the true relative positions, and I say tho members of tho Board may very easily have gained a wrong impression.

“I am also taken to task for quoting fees outstanding and written off, etc., for.one year omy. In ibis I admit I may have been unjust. I have endeavoured to get a period of six years, but so far, being unable to get from the Health Department or locally a complete set, I am short of the year 1925. I will not therefore quote tlic figures till they arc complete. , “Regarding the methods of the Board, Mr. Victor Smith, a member ol the iffiv'.rd, is reported to have said: “What struck him most was the opposition which was accorded applications for assistance' from places outside of Palmerston North.’ Just what docs this statement moan? Is it an answer to why the borough has more patients than from outside. “Further on he is reported: ‘I was somewhat disappointed at the last

'doting of the Board to find so little discussion. Everything -.was brushed aside and I protested about being asked to pass estimates tn the amount of £90,000 or £IOO 000 in the matter of an hour or two. There was no chance of getting any idea of the why and wherefore of the expenditure Now that’s a beautiful admission from a member of the Board that spends our money. “Scandalous Treatment.” Cr. Hudgens said he would support the motion without hesitation. Ho wondered if’it was possible for anyone to got better in the Palmerston North Hospital with all the economy that was said to be practised there. He would like to see a commission because other matters in addition to administration would come under public notice. The food and drugs supplied to patients, he thought, were deserving of a little more investigation. Cr. Hudgens also thought it was a shame the way charitable aid was dispensed by Iho Board No doubt the officer carried out; tlic wishes of the Board, but if all h? heard was true, there was hero something that also needed investigation. Men and women had told him of scan daious treatment they had received when applying for assistance. He fell the Council could do nothing else than support the commisMou. The Hospital Board had had tlic confounded cluck to say the Council hud protested year in and year out and yet had done noth

■■ • He hoped there was sonu'thing doin" now.

Or. W. L. Filzherhcrt reminded tho Oonneil that the present, eonslitution nf Hospital Boards had freon in vogue for many years. Ho took the view that

each local body contributing levies should be directly represented on the Board and he thought the proper course would bo to approach tho Government in that direction. The Council was entitled to an explanation as to why there should bo an increase in tho levy and until it got that explanation, they were only beating tho air. Tho Board was properly constituted and tho members were giving their services in the interests of humanity, gratis and they were entitled to some respect. Cr. Fitzherbert said he was not prepared to support the motion on the bare statements brought forward. The Mayor said ho understood tho hon. medical staff had had » meeting. Cr. Fitzherbert: “Well, we want something definite. Figures published had shown that tho administration of the Palmerston North Hospital compared favourably with other New Zealand hospitals. All tho officers were capable and much of the criticism had been unjust. If tho Council could prove tho expenditure wasteful then it should lie stopped but no proof was forthcoming as yet.” - Cr. B. W. Low said he, too, could not support the motion as he had not heard n word showing the capital expenditure f-o be unwarranted. He wondered how tho Council would feel if someone suggested ‘hat a commission should be sot up to inquire into it"- doings. The “ouncil would not altogether relish 1 hat. Another reason for his opposiMon to the motion was that the Direc-tor-General of Kospi'ols, a man who was keen on stopping undue expenditure, had sanctioned tho Hospital Board’s present propo als. The Council '■■ust have some more sor ous reason for a commission than that given. 'Person•M 1 y he thou'-M. the method of control was not the best. A hospital was a •e-om-rdf-v service and everyone who contributed to it should have the right fp be n. p"“ent. Further, ho thought there should be a visiting medical stall! ’nr ho quepMonnd the wisdom of an honor"rv nmdical staff. Another reason why persons should go to a public V>?p* t"i who C-'U l ' l . afford to pay. was that there were facilities there not to bo found in some of the private hospitals He thought a conference be‘■ween the Board and the contributing bodies might do a lot of good. Cr. G. Tremaine said he was going to support the motion as a result of what he' had learnt about tho Board basing its expenditure on established beds instead of occupied bods. There was scope for inquiry there. Or. W. M’lvcrton objected to the Council being made a laughing-stock of. They had no control of the Board jfs members endeavoured to do their best for tho ratepayers. Cr. Mam-ford asked what the scope of tho commission would bo aud who would pay for it. mP Mayor replied that the Borough would not bo expected to find tho cost. Cr. Eliott, in replying to criticism, asked Cr. Milverton if be realised that the increased hospital levy was one of tho causes of tho increased rato this year. He also assured Cr. Fitzherbert that the hon. medical staff of tho hospital had had a meeting and four or five were prepared to back up his statement that tho expenditure proposed by the Board was unnecessary. They wore oven prepared to give evidence before tho commission. Tho scope of tho commission would ho fixed by tho Minister and as (ho latter would be in Palmerston North next week, he suggested a deputation from the Council with the v-"w of nlno'ng the whole position in front of him. An Amendment. Cr. Low moved as an amendment that •a conference of representatives of local bodies be arranged to discuss with tho Hospital Board, tho proposed capital expenditure. He -would regret the adoption of extr/mio measures. Cr. Fitzherbert seconded, pointing out that a commission would bo a cost ly matter and a conference would do more good than a dozen commissions. Cr. Ilodgens spoke at this stage in favour of the nationalisafon of hospitals, stating that under such condi tions tho administration would come out of tho general taxation of the Do minion and then thorv would bo no

need of all this town versus country strife. Ho urged that the charitable aid department should bo revolutionised and that the Labour Department should be given the control of that matter. He could not sco any good arising from a conference at ill's juncture He did not think the suggestion should come from a contributing body Vit i--’tl l1 1 r the Hospital Board itself. Cr. Hansford did not think much ground would be gained by a roundJ »hh« conference with the Hospital Board members in their present atfi tudn to the Borough Council. Or. Bliott opposed the amendment as well as stating that only an impartial •• •• would find a solution of the position. Cr. Milverton supported the amendment because he thought the suggestion of a conference a fair one. The amendment was lost only C’rs I.nw Fitzherbort and Milverton voting for it. The motion was then carried. It was then decided to meet the Minister in deputation next week when the matter will again he discussed with him. Cr. Mansford concluded the discus "ion by moving that the Hospital Board ho asked to furnish the following particulars relating to the rear ending. M-rch 31, 1928: (1) The number of days the various r.aticnts waited from date of entrance tn date of operation. CL’) Whot number (if any) patients admitted for operations but left without such and the number of tin vs (hoy remained in the hospital. CD The list of the administrative taff ("with ear allowance and house allowance, if any) comprised In the estimates of C2ool. (I) The price offered for the block of sections in Rnahine Street and the • price they arc now being sold at.