H.—3l

16

ing thereof. He will watch the revenue, and ensure that it is being collected, and his costing returns will accurately indicate where there is waste in use or lack of acumen in purchasing supplies. The did ies of the Inspector of Supplies and Establishment would be very important and require varied and detailed knowledge of institutional management. He would report, and advise upon the methods of purchasing, storage and use of all articles, fhe prevention of waste, and the economical utilization of waste products. This officer would require to possess considerable tact if friction is to be avoided with Matrons and other professional officers. As his duties, however, would lie within the House Steward's Department, such a contingency should be avoidable. The question of filling this important position is at present receiving the consideration of the InspectorGeneral. The efficiency of (he House Steward is one ol" lhe most important factors in the economical administrations of the hospital, and upon such depends to a very large extent the expenditure of the institution. It is necessary thai the House Steward should be a thoroughly trained and experienced officer, and Unit his work and results shall be closely watched and inspected by an Inspecting Officer who has had actual practical experience in hospital administration and economics. Of the important administrative officers in the institution the House Steward is the only one from whom is demanded no certificate of training and competency. Medical Superintendents, Matrons, and nurses have to be proved by a certified period of training—not so the House Steward. Bursaries and scholarships are granted to medical students and others, and elaborate arrangements are made and facilities offered for the training of bacteriologists. The question suggests itself as to whether at one of the largest hospitals in whoso administration the House Steward's Department is complete and scientific there should not be established a course of training which would enable a sufficient number of competent House Stewards to be available to fill institutional needs. There is a growing tendency Io appoint House Stewards among the various institutions—appointments that where previously confined to the hospitals in the four chief centres. During the past year two hospitals have made a departure in this direction. Certain, difficulties present themselves in connection with the purchasing of hospital supplies. The Department can hardly insist upon Boards agreeing to its purchasing their supplies without giving some close indication of to what extent it proposes to save Boards' expenditure or purchase to better advantage than they themselves are doing. If the Department finds that it can actually quote certain lines at definite prices which are lower than those at present paid by the Board, then the difficulty to a great extent disappears, but under present conditions, when such buying is done from hand to mouth, and prices are so unsettled, the problem is by no means simple. The Military Supplies Branch of the Defence Department has been most helpful to this Department and has promised assistance in this respect. The Department has taken steps in regard to the attachment to this office of an officer experienced in (he purchasing of supplies, whose function it, will be to devote his whole attention to the matter, and it is hoped that good results will follow this appointment. The Department has already made one venture and purchased lint, cotton-wool, and gauze to the extent of £1,750, delivering the same direct from the manufacturers to the institutions at a time when (he same would have been practically unobtainable locally in the same quantities and was realizing much higher prices. It is considered that by this transaction alone the Department saved such Boards as availed themselves of its action about £500, and. moreover, prevented a dearth in a commodity that would otherwise have arisen. The officers above referred to would work in close collaboration in the matter of institutional supplies— e.g., the Inspecting Accountant's duly would be to report the quantity and price of, say, a certain article purchased by a. Board. The Inspector of Supplies might report with a view to standardizing supplies, (hat another material would be just as suitable, or that a saving could be effected by a difference in size. &C. The Puchasing Officer would point oul thai the material could have been purchased at a lower price, would show the saving that would have resulted, and would be prepared, if desired, to place orders for the Boards accordingly. The Boards of the four chief centres are in a much better position than the smaller Boards in the mater of purchasing their supplies, and in some directions have purchased to advantage. The Secretary of the North Canterbury Board recently reported having made arrangements with a Home firm which would result in still further economy. The smaller Boards, however, cannot, much as they may desire to do so, make such good arrangements, and it is only by co-operation, the desire for which has been expressed by more than one Board, thai anything can be done to assist them. In this connection appreciation must be expressed of the Director of Equipment and Ordnance and the Officer in Charge of Medical Stores of the Defence Department for their readiness and willingness at all times fo allow their stocks to be drawn upon. Influenza Epidemic Expenditure. I have already dealt fully with the financial administration of the epidemic in the Journal of Public Health this year (pages 6 to 119), under the heading of " Financing the Epidemic " and " The Economical Administration of Epidemic Expenditure," there is no need, therefore, to go into this matter at length. An analysis has been made of the expenditure both as regards the hospital districts in which the money has been spent and also under the various headings, such as medical