HOSPITAL AND CHARITABLE AID

Otago Witness, Issue 3029, 3 April 1912, Page 7

HOSPITAL AND CHARITABLE AID

MEETING OF COUNTRY DELEGATES IN DUNEDIN. In the board room of the Agricultural Buildings in Dunedin a oonierence was held on March 28 of delegates from local bodies in the Otago district who contribute to the Otago Hospital and Charitable Aid Board to protest against the expenditure they a.ne. annually called upon to make to the board. There were present, among others, the following gentlemen : —Messrs H. O'Neill and K. Cameron (Waihemo County), R. Riddle and W. Robertson (Palmerston Borough), A. S. Orbell ajid A. Kilpatrick (Waikouaiti Countv), Neil Stewart (Waikouaiti Borough), G. L. Asher (Port Chalmers Borough). W. Crawley and R. Dewar (West Harbour Borough), J. D. oameron and W. J. Burk (St. Kilda Borough), A. J. Butterfield and E. S. Clarke (.Maori Hill Borough), F. Doherty and W. Blackie (Taic-ri County), H. 11. Inglis (Mosgiel Borough), J. M. Begg and J. Clark (Bruce County), C. King (Milton Borough',, and J. B. M'Kinlay l±>awrence Borough). Mr J. H. Walker (chairman of the Otago Hospital and Charitable Aid Board), and Mr J. Jacobs (the board's secretary) were present by invitation. On the" motion of Mr Blackie, seconded bv Mr Begg, Mr O'Neill (chairman of the Waihemo County Council) was voted to the chair. The Chairman said, as they were all aware, they had met to discuss matters in connection with the administration of charitable aid by the various hospitals and charitable aid boards thi-oughout the Dominion, and also to protest against and endeavour to remedy the extravagant system of administration at present obtaining under the Otago Hospital and Charitable Aid Board. His attention was first drawn to the extravagance of the Otago Board six months ago, when, on comparing the balance sheei of the Waitaki County with that of Wai hemo County, he found that the Waitaki County's contribution to the Waitaki Charitable Aid Board for the vcar ended 31st March, 1911, was £570, while that of the Waihemo Council to the Otago Board for the same period was £460. The total rateable property in Waitaki County was £3,698,812. while in Waihemo County it was only £536,878. Consequently, although Waitaki County contained, roughly speaking, rateable property valued at seven times the amount of Waihemo, the annual contribution paid by the last-named bedy almost equalled that paid by Waitaki. To put the position more clearly: If Waihemo had been included in tho Waitaki charitable aid district instead of in the Otago district, the contribution for charitable aid for the vear ended 31st March, 1911, would have boon £9O instead of £460. The two counties mentioned adjoined, but a proportionate difference in tho figures would bo disclosed on comparing tho amounts levied on other local bodies included in the Otago charitable aid district. From the annual report presented to Parliament by the Inspector-general of Hospitals, statistical information might be obtained which would conclusively prove that the local •bodies controlled by the Otago Board were being called upon to pay contributions far in excess of local bodies fortunate enough to be included in other charitable aid districts. Mr O'Neill then epicied figures showing the estimated Hospital and Charitable Aid Board expenditure for the year

ending 31st inst., and the: amount thereof to be raised by levies cm lecal authorities. His figures" may be summarised as follows, the rate "per £IOO being on the capital value included in the respective districts :

Thirteen smaller boards were not included in the return. The complete return showed that the total amount contributed by the local authorities of the Dominion for Hospital and Charitable Aid Board purposes tor the year just closing averaged 10-Jd for every £IOO of rateable capital value, whereas the local authorities included in the Otago charitable aid district had been called upon to pay Is 7£d, or nearly double the amount for tho Dominion. Tho question then was what steps should be taken to remedy the existing state of affairs? In the Waihemo County they were at present paying nearly one-third of their rates in Hospital and Charitable Aid Beard contributions, and as the lew was increasing year by year, it was decided to invite representatives appointed by the local bodies concerned to meet in conferenoe for the purpose of considering the position. He was not prepared to say in what way the Otago Board was wasting money, nor could he point out any specific act of extravagance, but he claimed that the figures quoted showed that tho local authorities included in the Otago Hospital and Charitable Aid District wero paying more for hospital and charitable aid purposes titan did similar bodies in any other part of the Dominion. —(Applause.) Mr Orb ell said the reason for holding the conference that day was that for some yaacre. the amount required as a levy from the local bodies to keep the Hospital and Charitable Aid board in funds had been rapidly increasing) until it now had become a very severe tax on local bodies. At the outset he would like to say that he was sure he was expressing tho feelings of the whole of the county delegates when ho aaid that it was not their wish to do anything that would interfere in any way with the welfare of the sick and poor. They had their sympathy, and lie thought he could safely say that country people were always ready to lend a helping hand to those in need or in sickness.—(" Hear, hear.") What they desired to say was that tho present administration of the Hospital and Charitable Aid Board! was extravagant, and that the people wero not getting the best they should for tho money contributed. Of course, ho admitted it was no use making this bald ' statement without being able in seme way to substantiate it by figures, and he would endeavour to put a few facts before tho meeting to prove the statement lie had just made. His figures wero principally taken from tho Year Book of 1911, and ho did not suppose anyone would be bold enough to say that the returns as given in this book were not correct. They would find on page 461 that it cost the Dominion for hospital maintenance and charitable aid a sum of no less than £416,334 for tho year 1911. The items that went to make up this sum, as compared with those in 1910, were as follow : 1911 1910. Hospital maintenance ...£200,691 £187,922 Charitable Aid:— Indoor relief 62,348 53.83 C Outdoor relief 33,051 38,988 Administration ... 20,446 17,295 New buildings and additions 81,473 69,719 Oilier expenses 17.575 7,321 Totals £416,384 £375,075 A very useful item was this " Other expenses." It increased from £7321 in 1910 to £17,875 in 1911 —an increase of over £IO,OOO, while the increase in one year was about 150 per cent. But it was the totals for the year they were most interested in, and here they found that for the year 1910 it cost the Dominion £375.075. and' in 1911 £416,334, or an additional £41,309, an increase of over 11 per cent, in one year. They must not forget that during the last 10 years tho amount paid out in old-age pensions had nearly doubled itself. In 1901 it was £197,292, and in 1911 £383,392, so that it now cost the Dominion for oldage pensions £186,100 every year more than it did in 1901. Now, lot them look at tho cost- from another point, and again ho t<cok his figures from the Year Book of 1911, anc? extend them over a period of 10 years —from 1901 to 1911. The proportion of expenditure per head of population was: —-- 1901. 1906. 1911. s. d. s. el. s. d. Hospital 3 1 3 10 4 11-i Charitable aid ... 2 0| 2 4 2 8i Added together ... 5 12 6 2 7 8 i So that, in 10 year 3, the cost per head of population had increased' over 50 per cent

If thev added the cost per head of population "that the Dominion paid for old-age pensions, they found that it, mounted to no less a sum than over 15s per head of population. Let- them contrast that with the cost of the upkeep for hospitals in Great Britain. The Hon. Mr I'owlcte, in a sweooh made in the House, stated that in Great Britain the cost of hospitals per haad of papulation was Is Id per head, and in New Zealand M, lie had gone rather fully into what it cost the Dominion for hospital and charitable fid ; n order to show that tho Dominion as a whole was very liberal in its payments as compared with Great Britain. .Now, ho would come nearer home and endeavour to show that the cost of running the Utago district was verv much greater as compared with other districts in the Dominion, and that the levy made on Che local bodies was very much higher than that made by other Hospital and" Charitable Boards. Waitaki joined the Otago Board on the north, and he would take that district and compare it with the Otago district. In Otago the amount payable by local authorities on every £IOO of their capital value was Is 7 2 d, and in Waitaki 3|d. Why this great discrepancy? It looked as if the Waitaki district, consisting as it did principally ot farmers, was better able to manage economically an institution of this sort than the commercial men of the town. And what did this great difference of admniistration mean? It meant that for every £1 the people in the Waitaki district had to contribute, if they had been unfortunate enough to live over the boundary and in the Otago district, they would have had to pay £5 3s—or more than five times as much. In the Waikouaiti County the contribution last year to the Otago Hospital and Charitable Aid Board was £694 2s, and here ho would again like to take the same period of 10 years, from 1901 to 1911, ar.ld show how the Otago Board had piled on tho agonv and increased the levies. In 1901 the "county paid £333; in 1806, £331 17s 6d; and in'l9ll, £694 2s. It would be noticed that in the first period of five years there was no increase, but in the last the levy required was more than doubled. It now took more than one-fourth—nearly onethird—of their total rates to pay the hospital and charitable aid levy. He had said that the Waikouaiti County had to pay £694 2s to the board. If this levy had been made at the same rate on every £IOO of capital value, as they had to pay on in the Waitaki County, they would only pay £155 instead of £694. In other words, the payment they now made would have lasted over a period of over five years. Some of them might say it was hardly fair to compare a county board against a town one. lie did not sec- why; but, in case someone might think so, he would take Wellington. This district hud a rateable capital value of £28,213,453, against Otago's capital value of £19,297,931. Wellington only levied at the rate of on every £IOO of capital value, while Otago, as ho had already pointed out, wanted Is 7id —more than double. Other districts near Otago were Wallace, with a levy of 7£d, and South Canterbury, Bd. Again, take the cost of maintenance per occupied bed. The average cost of this in all the hospitals of the district was £96 19s. The average amount of payment per patient per occupied bed was £2O 17s; therefore the loss to the Dominion per occupied bed was £76 2s. He had not been able to arrive at the actual amount received from patients per bed in the Dunedin Hospital, but there was a dead loss of £92 17s Bd' in Dunedin as compered with Wellington's £7O 16s sd, or a difference of £22 Is 3d. The average time a patient was in these two hospitals was practically the same —25 and 26 days. Mr Orbell also referred to the Infectious Diseases Hospital, which, he said, had been a very expensive building for the country people. He favoured tho establishment of cottage hospitals in different districts. It was not possible for country people who were stricken with fever to como to Dunedin to enter the hospital there —(Applause.) Mr M'Kinlay expressed the opinion that the building of cottage hospitals led to extravagance. Mr Asher held that local bodies ought to know how the money was being spent, and they would then be able to say how far there was extravagance in carrying on the work of the board. The demands of the board now absorbed about one-third of tho general rate of the Port Chalmers Borough. Tho general rate was Is 3d in tho pound, and of that fully 5d had to bo contributed to the Hospital and Charitable Aid Board. They should ask for an amendment of tho act making it obligatory on the part of the board to supply the contributing bodies annually with a statement of its income and expenditure. Mr Blackie said ho was there as a delegate, and also as a memb&r of tho board. The Taieri County Council had to pay a considerable sum to tho board—£ls7o.—but since he had been a member he could not see any in which tho payment could bo reduced. The levies in the four centres were:—Auckland, £45.000; Wellington. £42.000; Canterbury, £29,000; and Otago, £23.000. The Waitaki County had been spoken of, but it was hardly fair to compare it with other districts, for the reason that it had largo endowments and a frco hospital. At the invitation of tho Chairman. Mr Walker addressed the conference. He said he would have great pleasure in answering the points raised, though he would have to do so at such extremely short notice. It seemed to him that the comparison with

Waitaki was unfair, as Waitaki was fortunate enough to possess one of the few free hospitals in the Dominion, the local board paying nothing towards its upkeep. The expenditure of the boards in the four centres were-.—Auckland, £45,000; Wellngton, £42,000; Canterbury, £29,000, and Otago, £28,000. Both tho Auckland and Wellington Boards were well endowed, Auckland having reserves which capitalised amounted to £500,000. Wellington, received £BOOO in donations to the hospital as against £BOO donated in Dunedin. The members of the Otago Board were all alarmed at the increased expenditure and levies necessary, but he feared they would continue to increase. The fact of the Medical School being in Dunedin greatly increased the Hospital expenditure. The cost of maintenance of Dunedin Hospital compared favourably with Auckland or Ohnstchurch, while Wellington Hospital was more economically administered because there were double as many beds there as at Dunedin Hospital, besides whioh Wellington had other advantages in its different system of charging for the cost of patients in what corresponded to our Benevolent Home. The total cost of our Fever Hospital was £4OOO, and if Government requirements were carried out it would be nearly doubled. Dunedin City paid £6OOO a year towards hospital and charitable aid. Then the Consumptive Sanatorium was a great burden on the board—one which the State ought to relieve them of. If this sanatorium were enlarged to four times its size it would barely accommodate all who wanted admission. Mr Walker went into details of increased charges at the Dunedin Hospital, and maintained that it was unavoidable that increased maintenance charges should result. The board could not be more economical in its administration than it had been. It was, however, increased capital expenditure, and not increased maintenance, that had necessitated heavier levies. The reason why no balance sheets had been printed was solely on the ground of economy. It would have cost £BO. As to motor cars, business men would not serve on tho board unlses their time was economised, and tho board had found motor cars cheaper than railway travelling. If the public knew, it would be quite satisfied with tho board's method of doing business. Though there was tho question of a secondary' hospital to be faced, tho board had certain funds in hand for the purpose. —(Applause.) Mr M'Kinlay said he did not object to the board having motor cars. It was tho way they were" used that had caused a good deal of "talk. In Lawrence, for instance, some alterations were applied for by the resident doctor, and it was supposed they would cost £2OO or £3OO. But two car-loads of members and an architect arrived on tho scene and inspected tho place, and tho cost in tho end was nearer £IOOO than £3OO. It would surely have been sufficient for a committee of tho l>oard to have made an inspection and report to tho board. Again, he did not approve of Ihe manner in which hospital accounts wore collected; there was a great leakage there. There was far too much written off. The aid of local authorities should bo invoked to assist in the collection of the money. There were persons in a comfortable position whose accounts had been written off. As for the consumptive sanatorium, he thought pressure should be brought to bear on the Government to take it over, seeing that thoy controlled similar institutions in other parts. Mr Walker sail tho amount expended ar. the Lawrence contract was £217 3s 4d and, with other work done, tho expenditure bad' not exceeded £3OO. He explained the method of collecting accounts. The amount collected last year was £3755 5s 2d. The Chairman asked if there was a Inpatient in the hospital from Waikouaiti or Waihemo should not tho board advise the clerk, That might help the board considerably, and prevent persons escaping payment. Mr Walker replied that inquiries were made concerning oases from those in a position to know about them. It had been found in somo cases that the local bodies were interested in the people concerned, and in that way they went free. Ho did not think, however, that much of that liad occurred in tho last two years. Replying to other questions, Mr Walker said that each bed co?t tho hospital £92 per annum, and they received back 7s i>«r patient per annum. It was very difficult indeed to collect hospital accounts. The outcry all the time was for free hospitals, and it seemed to him the Government' would mako them free yet. The printing of tho balance sheet and report would have cost about £HO and the board decided not to incur the expense. If any local body wanted a copy of the balance sheet it could, lie thought, obtain one in typewritten form. If tho receipts of other hospitals ivoro looked into it would bo seen that, in that respect. Dunedin compared very favourably with them. Mr Blackie said bo thought the board ought, to supply to local bodies a list of all recipients of charitable aid, and a periodical statement of defaulters. He intended to bring up a motion to that effect at the next meeting of tho board. Mr Walker pointed out that tho board had to nay over £SOOO a year in connection with industrial schools over which it hod no control at all. The estimated expenditure for tho year 1912-13 was as follows: —

£ b. d. £ a. d. Dunedin Hospital 17,863 12 4 Less receipts 3,655 5 2 Fever Hospital 499 3 1 Less receipts 115 8 2 . 383 14 11 Palrnerston Sanatorium 4,304. 6 9 Less receipts 863 10 5 I Less capital expenditure 965 12 9 Xuapeka Hospital ... 1,054 7 8 | Less receipts 142 15 7 Less capital expenditure 217 3 4 1 094 S • Maternity Hospital ... 810 0 5 i Less receipts 338 11 9 I _ 171 S f Kaitangata Hospital ... 416 19 8 I Less receipts 33 1 0 I Less cu-pital expenditure 224 17 8 i 153 16 0 Port Chalmers Hospital 255 1 0 I Less receipts 1 11 0 Less capital expenditure 80 1 0 Benevolent Institution 5,131 12 0 I Less receipts 2,224 3 2 ] Less capital expenditure 224 16 6 Outdoor relief 4,281 19 11 i Less receipts 145 17 6 Industrial schools and | homes 4,130 12 11 Less receipts- 869 17 11 i 3,260 15 0 Officials' salaries WM 0 0 : Printing and stationery 142 18 1 Miscellaneous 499 13 5 . Petty cash 85 0 0 i Travelling expenses ... 133 17 7 j 718 11 0 Other boards' maintenance 125 5 8 Puplic Health Department ... ... * 97 15 * Total ~.£31,303 7 6 In reply to a delegate, Mr Walker said it | was not' anticipated that the levy would ' be more this year than last year. i Mr Orbeli asked where the board -ibtained its revenue. There was so much from Local bodies, Government subsidies and donations? Was there any other source? Mr Walker: No. Mr Orboll went on to say that the man in the street pot off free. There wero hundreds of people walking the. street* who paid not a cent to the upkeep of tho hospital. That was a reason why the money should be paid out of the Consolidated Fund by the Government instead of by levies on local bodies. The hospital was for tbo benefit of everyone, and way should a certain class escape payment for &3 upkeep? ~ i Mr Riddell said the Palrnerston authorities had been informed that a patient from J-h.it town could not be admtted to the Fever Hospital, as he could bo much better treated in his own home. He gave details of thi3 case, that of a boy, and maintained that a. great hardship had been inflicted on the parents by two board's refusal to admit him. , , Mr Walker replied that the parents of this patient had all the facilities for isolation in their homo, and medical aid was at hand; neither were they in indigent circumstances. Ho invited the delegates to visit any of the institutions while they were in town. Speaking of the hospital accounts, 'he said that at its last meeting the board wiped off £3OOO. When it took over the hospital it took o\er a "legacy" of old d?bts amounting to £IO,OOO. These were being wiped off gradually, as th *'£r* worth nothing. i Mr M'Kinlay asked if the Government took over the control of the institutions would it affect the efficiency of them V i.ir Walker said it was the intention of . the Government to bring in a bill to take over the institutions. T£«SV would be controlled bv a larger h6dr, which would look after a number of matters. When the subject was discussed in Wellington Dr Valmtino suggested that if the control of consumptives' sanatoria was proposed to bo ; taken over bv the Government he would SUfgcst that they should be left to tho local boards to administer, because they could administer them cheaper than if they were administered from Wellington. Dr j Yalintine, he thought, was right. Mr Clark (Bruce) suggested that tho ' board should seek tho assistance of tho local bodies in making ex-patients pay for treatment. I Mr Clark* (Maori Hill) said tl-. been no explanation of Mr O'Neill » e* Ifr Orbell's figures. Mr Walker had failed to explain why the Otago Board's levy was j Is 7 id, as against tho average of 10a per £IOO for the dominion, and a considerably smaller sum in certain districts. Mr Walker had told them tliat they ought to bo glad' to have tho Medical School in Dunedin, and willing to pay for the privilege. He did not agree. Medical students came hero from all parts of the Dominion; ar.-d ho failed to see why tho Otago people should have to contribute more towards their education than the people of the districts from which they cam?. He moved that ( the conference should set up a committee of five to investigate the reasons why there was suo&i a difference between the cost of the Otago district's administration and that | of other districts. ; Mr Riddell said that it would be waste of time to carry the motion, as it would ■mean that no further progress could be made that day. Ho inquired for details of the Palrnerston sanatorium—how many patients xyc---c there, and how many were ' paying, ffd how many were not, and who they were. | Mr Clark (Bruce said this information should be furnished in regard to all the hospitals. 1 Mr Walker said that at the sanatorium

iho upkeep was £2535, and the receipts "from patients were £863, or about a third. "Xiany of the patients did not and could not pay, and'-they ■•. could not be refused admission. . " Mr Begg referred to the abnormal cost cf elections. Formerly tJie local bodies nominated their representatives, which cost nothing. Last election in Bruce cost £230, or about 7s 6d for every vote polled. The old system should be reverted to. a After further discussion the meeting was ibrought to a close with votes of thanks to Mr O'Xe'dl for presiding and to Mr Walker for his address.

Rate per District. Lew. £100. Marsden £1.950 Is 4Jd Auckland 14,058 Is Id Wuikato 4,000 0s 10Jd Cook 2,563 0s 8d Hawke's Buy . ... 3,758 0s 5Jd Taranaki 1,881 Ob 8d Waipnwa ... .. . ... 2,881 0s 74d Stratford • . 903 Os 8Jd Hawera ... „ 1,124 0s od' Wnnganui . ... 3,130 Os 6|d Palmorston North ... . 2,63f> Os 5 id Wellington . ... 11,044 os aid Wairarapa . ... 2,614 Os 6d Walrau 1,702 Os lid Nelson 1,893 Is Od North Canterbury ... 19,275 Is Id Ashlmrtou 1,379 Os 4Jd South Canterbury 3,950 Os 8d Waitaki 691 Os 3Jd Otago 15,808 Is 7£d Southland 4,445 Os 10.1 Wallace 754 Os 7Jd