5

H.—3l

any great increase in their rate of levy, but it naturally results in an increase in the subsidy during the year. Much of the remainder of the estimated increase is due to the amount of levy and subsidy that has to be raised to meet the heavy interest on loans which, during the preceding few years, showed a tendency to increase to an alarming extent, but has now reverted to more normal proportions. Further particulars in regard to Hospital Boards' finance will be found in the appendices to this report, which, will be published after all the returns and balance-sheets are received from the various Boards. Further information in regard to tho departmental income and expenditure will also be forthcoming upon the publication of the Department's balance-sheet. Accounting for Stores and Equipment. The Department has always been alive to the necessity of stores-accounting being as accurate and reliable as accounting for cash, and during the year compiled in a handy pamphlet form its stores system for the guidance of officers concerned and others interested. In its inspectoral capacity also it is endeavouring to induce Hospital Boards to adopt, where such has not already been done, adequate and. sufficient stores systems and records. Owing to the shortage of staff in the Inspecting House Manager's Department not as much, has been done in this respect as is desired, but with the strengthening of the staff at Head Office a greater amount of inspection and education of institutional officers will be possible. A little tact and personal explanation is often required to induce Board officials to adopt a proper stores system, more particularly in the case of the small institutions in which there is no clerical staff available on the spot, necessitating the Matron having to undertake the stores accounting. Many of them, though realizing the necessity of properly accounting for cash, do not realize,the necessity for the. same care in accounting for stores passing through their hands. Patients' Fees. The matter of the collection of patients' fees will be dealt with at greater length in the hospital appendices. Suffice it to say that, with the enlargement of our hospital service, the increase in medical knowledge, and the consequent elaboration of our institutions, with the natural tendency — and, in fact, desirability of persons seeking treatment therein rather than in private hospitals, which cannot hope to compete with the general institutions in efficiency and equipment, it is all the more necessary that the matter of collection of patients' payments should be carefully watched and placed on a sound and satisfactory basis. A Hospital Board of any size dealing with a great number of patients' accounts would be well advised to set up, as the Wellington Board has already done, a separate Fees Committee to deal with all matters concerning patients' accounts. The mere sendingout of printed reminders or the engagement of a collector on a commission basis are of little good by themselves. The amount which tho patient can pay, either at a certain, date or by regular instalments, having been ascertained definitely, upon or before his discharge, then such patient's account should be brought up for review upon the dates on which payment is due as promised, and in cases where a collector is employed to collect such amounts, any failure to receive the amount undertaken to be paid should be reported immediately by him to the Board's Secretary or Accountant, and the matter immediately brought up for review by the Fees Committee. There is a clear distinction between sentiment and a businesslike method in such matters. It is not urged that undue pressure should be brought to bear upon those in poor circumstances ; in fact, it is noticed that often a promise to pay an amount is accepted without question where, upon the slightest consideration of the circumstances, it would be evident that the patient could not possibly pay the amount promised. It is of little use a Board official accepting such a promise to pay, which only inevitably results in a bad debt. The whole question of the patient's finances should be gone into early in the proceedings, and the amount of the debt reduced, if necessary, and also the necessary concession, given as regards the period and amount of instalments by which the amount can be paid. This having once been settled, the ex-patient should be expected to abide thereby, and any default in meeting such engagement could only be justified by a change in the patient's circumstances, full particulars of which should be placed before the Fees Committee for its consideration. The tendency of some Boards to allow accounts to accumulate on their books is an undesirable one. Though patients such as small farmers may not be in the same position as wage-earners as regards paying their accounts by regular instalments, but may be able to pay their accounts in full if given time to do so, there is yet a limit to the time for which an account should be allowed to run, and, generally speaking, something should be expected to be paid within twelve months. In fact, a patient who on discharge can show satisfactory reasons why he cannot pay his account within a twelvemonth presents a very good case for a very considerable reduction being made in his account; and, generally speaking, there is no warrant for sums amounting to many thousands of pounds being allowed to accumulate and be entered on a Board's books from one year to another. Constructional Inspections. During the year plans were approved for the erection, addition, or alterations to hospital buildings estimated to cost £373,769. The Technical Inspectors, by the careful checking of plans Before approval is given, have effected many improvements which not only add to the efficiency of the hospital, but in many cases have considerably reduced the cost, to the extent even of as much as £10,000 each in two cases. Plans and specifications for new buildings, also for the engineering services, have been prepared and the work carried out in its entirety by the Department, to the complete satisfaction of the Boards concerned. The