HOSPITALS.

Otago Witness, Issue 3513, 12 July 1921, Page 51

HOSPITALS.

ROYAL COMMISSION’S REPORT. IMPORTANT RECOMMENDATIONS. e WELLINGTON, July 9. Many important proposals are contained in the report of commission appointed to inquire into hospital control and allied matters, which was made available for publication by the Hon. C. J. Parr (Minister of Health) to-day. The commission’s findings, which appear in some vital points to endorse the views expressed by the Minister last season, are summarised as follows : 1. (a) The Government should contribute one-lialf of the capital requirements of hospital boards. The basis of such contributions should be a flat rate subsidy of £ for £ on the c-apital expenditure and on interest on loans current in respect of capital expenditure, (b) The cost of minor capital works, and all plant and equipment should be provided for otherwise than from loan. The cost of erecting buildings, or of ■making additions or alterations to buildings, or purchasing land, may be raised by loans. Loans should be repayable by a sinking fund within a. period not exceeding 20 years for permanent buildings and land, 10 years for wooden, where non-permanent, buildings. The Government should provide facilities for hospital boards to obtain loans on the most advantageous terms. 2. (a) The Government should contribute one-half of the net maintenance requirements of hospital boards, (b) The basis of allocation of 19-20i:hs of such contribution among individual boards should be on the principle that the heavier the burden of a board’s requirements on rateable capital value of a district the higher the subsidy, but that the rate of subsidy, per £ levy, should not exceed 255, nor be less than 14s in the case of any individual board. The remaining l-20th of such contribution should bo specially allotted in equal proportions to hospitals at Auckland, Wellington, Christchurch, and Dunedin for the purpose of developing and extending the work of special departments essential to hospitals, but should not be used in any case for ordinary maintenance purposes. In view of the special subsidy contribution, other hospital boards should have the right to send patients for admission to these hospitals for special treatment, on payment of the maintenance fee. In arriving at the burden of a- board’s requirements on the rateable capital value of its district, a deduction should be made for such rateable capital value of all non-rate-producing Native lands. 3. The Government should subsidise voluntary contributions to hospital boards for general maintenance purposes, or for special maintenance purposes approved by tiie Minister, at the rate of £ for £. The Government should, on the recommendation of the Minister, subsidise voluntary contributions, bequests, and clevises for capital purposes, or endowments, at the rate of £ for £. 4. (a) The Mercury Bay Hospital should be merged _in the Coromandel Hospital district. . (b) Oamaru Hospital should continue to be treated as a separate institution under tlio Hospitals and Charitable Institutions Act, and receive the same scale of subsidies as a hospital board, (c) The Jubilee Institute for the Blind in Auckland is an educational institution, and, as such, should be removed from the list of separate institutions under the Act, and in future should receive financial assistance from the Education Department, (d) The Reefton Ladies’ Benevolent Society should be removed from the list of separate institutions, and be affiliated with the Inangahua Hospital Board, (e) The Wellington Convalescent Home, St. Andrew’s Orphanage (Nelson), the Wellington Ladies’ Christian Association, the Hawke’s Bay Children’s Home, and the Wellington Society for the relief of the aged and needy should be continued as separate institutions, and receive the same scale of subsidies as hospital boards on voluntary contributions and bequests. ' * 5. The Plunket Society and the Salvation Army should continue to receive financial assistance from the Government through the headquarters of each organisation. The Government should make an annual grant to other charitable societies and institutions, and allow the same on the recommendations of hospital boards, having regard to the amount of voluntary contributions, and the number of inmates. 6. (a) A uniform fee of £3 3s per week for adults and £l 11s 6d for children under 14 years of age should bo charged for maintenance and treatment in public hospitals, boards to have permission to reduce such fees in necessitious cases; boards to have power to contract with friendly societies for the maintenance and treatment oi their members on a guaranteed payment of onehalf the above fees-, (b) In order to extend further their usefulness, there should be established in connection with public hospitals, wherever the conditions are favourable. private wards to which patients would bo admitted on payment of adequate fees for maintenance and nursing attendance, such wards to be under the control of the medical superintendent, Jjut patients to choose their own medical attendant, and make their own arrangement as to his fees. 7. (a) Section 9 (2) of the .Hospitals and Charitable Institutions Act, 1909, should ire amended so as to allocate representatives of contributory districts in " proportion to their respective rateable capital value and population, at the ratio or two-thirds on the rateable capital value, and one-third on population. (b) The existing system of representation and suffrage should continue, except where local contributory bodies, having different forms of suffrage, are united in one combined district. In such a case the ratepayers’ suffrage should apply over the whole area, 8. Considering the full power of control of expenditure already possessed by the

Minister, the Government representation upon hospital boards, by means of nominated members, is not recommended, except that-, in the case of the Auckland, Wellington North, Canterbury, and Otago Hospital Boards, to whom it is proposed to give special financial consideration for base hospital purposes, it is recommended that there should be one member on each board appointed by the Government, and, further, that in the ca-se of the Otago Hospital Board, an additional member should b 3 appointed by the Government to be nominated by the medical faculty of the University of Otago. 9. The constitution and area of hospital districts should continue as at present, except that the following hospital districts should be amalgamated: —Picton with Wairau, Inangahua with Grey, and Waihi with Thames. The public hospitals at Auckland, Wellington, Christchurch, and Dunedin should be constituted base hoe■jtals. Economy, the commissioner thinks, woqjd be effected to a very large extent by the adoption of the following recommendations : (a) A Hospital Supplies Purchase Board should be constituted under the Health Department, composed of one responsible, officer of, and appointed by, each of the four base hospital boards, one from the Health Department, one from the Mental Hospitals Department, and two business men nominated by the Minister. The board should arrange for the standardisation, purchase, and distribution of equipment and supplies for all the institutions under the hospital boards, Health 'Department, and Mental Hospitals Department. Hospital equipment and supplies, where possible, should be standardised, with a view to economical buying, by placing combined orders for delivery at centres as required. (b) An inspecting house steward should be a permanent officer of the department. Ho should introduce an efficient system of recording and checking the receipts and the issue of supplies at each hospital, and should report fully to the department and the hospital board affected after each inspection. (c) Two inspecting accountants should be appointed at once to introduce a uniform system of accounts and returns. They should introduce a uniform system of costing- .* (d) W ilii a view to assuring tfie most efficient design and construction of hospitals and standardising of buildings where possible, a specially qualified architect should be appointed. (e) A skilled dietitian should be appointed at ouoe by the Otago Hospital Board to organise at the Dunedin Hospital, in connection with the Home Science Department of the University of Otago, the training of pupil dietitians. As soon as possible dietitians should bo appointed at Auckland, Wellington, and Christchurch Hospitals by the respective boards. (f) A uniform system of medical records should be introduced into all hospitals. (g) It is suggested that as additional accommodation for patients becomes necessary in the largest centres a policy should be considered of building secondary hospitals for convalescent anti chronic cases. (h) In section ‘72 (1) of “The Hospitals and Charitable Institutions Act, 1909,” in line 1, after the words “when a person receives.” there should be added the words “charitable aid,” and a clause should be inserted in it amending the Bill empowering the boards "of Auckland, Wellington, North Canterbury, ant] Otago hospital districts to recover fro-m another hospital board the cost of special treatment given by any of them to any bona fide resident of that board’s district. (i) Medical research and preventive work of the Health Department should be further developed, with a view to improving the national health, thus lessening the need for hospital accommodation.