H.—9

1888. NEW ZEALAND.

HOSPITALS AND CHARITABLE INSTITUTIONS OF THE COLONY (REPORT ON).

Presented to both Houses of the General Assembly by Command of His Excellency.

The Inspectok of Hospitals to the Hon. the Colonial Seceetaey. Sib,— Wellington, 25th June, 1888. In my last year's report on the hospitals of the colony I gave a detailed account of their organization, and structure, and the accommodation each provided. This year, during my visits of inspection, the conviction was gradually forced upon mo that no comprehensive examination of our hospital-system was possible which did not rest upon and presuppose a careful analysis of the various methods by which the charitable impulses of the community find expression in our charitable institutions. I need not say that I was rather overwhelmed to find that zny office of Inspector of Hospitals committed me to such a task as I have found this to be. In examining the working of the outdoor department of our hospitals it became evident that they could not bo isolated from our general charitable system if I were to give any useful account of their operations, and that to find a base-line for this I must make up my mind to. acquire a direct personal knowledge of our various modes of outdoor relief by personally visiting and examining in their homes the recipients of charitable aid. The exceptional duties I had to undertake as Inspector of Asylums last year prevented me from accomplishing so much in this direction as I hoped; and it is only the urgency and magnitude of this problem of charitable organization that can excuse this fragmentary report on such a subject,. To show how the question of the outdoor department of our hospitals is involved with and merges in the general problem of charitable aid, I cannot do better than describe the state of things I found in operation in the two hospital districts of the Thames and Hokitika. The Thames Hospital is a separate institution under the Act. I)r. Williams, the surgeon, receives a salary of £450 a year and a house, without the right of private practice ; the head nurse gets £50; four nurses get £40 each; a cook, laundress, and an old patient who acts as gardener complete the staff, which cost last year £868 6s 4d in salaries alone. The total expenditure for the year was £2,210 15s. 7d., from which must be deducted £317 17s. Id. for real estate and buildings, leaving £1,024 12s. 2d. for supplies, &c, and of this the drug-bill amounted to £100 18s. 8(1. At the time of my visit there were ten patients in the hospital, but it must bo added that at times this number is increased considerably. The mere juxtaposition of these figures for salaries and supplies reveals a most extraordinary state of things, the explanation of which is to be found in the fact that the Trustees have thrown open the outdoor department of the hospital to all persons whatsoever, whether rich or poor, who are willing to pay ss. per week for advice and medicine. The result is that the general body of the taxpayers of the colony have, through the Government subsidy, to contribute towards giving cheap medical advice to the Thames people, by enabling the Trustees to undersell the local medical men by the competition of a salaried officer, and by the same moans towards injuring the druggists and undermining the self-respect of the people. During 1887 there were treated on these terms 1,339 individual patients with 3,357 attendances. I am informed that, in order to leave Dr. Williams free to overtake this rapidly-increasing demand for his services on these terms, the Trustees desire to relieve him of all charitable-aid work, which they want the local doctors, whom they are starving out, to undertake ! A somewhat analogous, though less mischievous, practice has grown up in the Westland Hospital District. The Trustees, by their by-law 18, say : " District Committees shall have the power to make a rule by which persons paying an annual amount to its funds shall Le entitled to admission into the hospital or to outdoor treatment free of charge during the year covered by such subscriptions ; but no such annual ticket shall be granted by any Committee for a less sum than ten shillings for each year." It is evident that these tickets are of the nature of insurance or benefit contracts, and cannot, therefore, by any ingenuity of argument be shown to be voluntary subscriptions, such as are contemplated by the Act. Yet I find that the Government has been paying without question £1 4s. in the pound subsidy on those payments. I find also that it is the custom for patients, no matter how long they may have been inmates of the hospital or receiving I—H. 9.