B.—4a

Act, and believe that the setting-up of a Permanent Board of Hospitals, with powers and duties somewhat akin to those possessed by the Hospitals Commission in New South Wales, should be the first step towards the end in view. This Board should be clothed with wide powers, and it is important that its members should be representative of both the ratepayers and the general taxpayer. We recommend that a Board of seven members should be constituted, and suggest the following personnel : — Minister of Health (Chairman). One representative nominated by the Counties' Association. One representative nominated by the Municipal Association. One representative nominated by the British Medical Association. One representative of Treasury. Two men of wide business experience. 71. We believe that with few alterations similar powers and duties to those possessed by the Hospitals Commission of New South Wales should be vested in the Board which we recommend for this Dominion. Briefly put, the duties should be— (a) To make, or cause to be made, careful inquiries into the administration and management of every hospital: (b) To close any hospital: (c) To amalgamate any two or more hospital districts and limit or extend the activities of any of the Boards : (d) To authorize or require the Board of any hospital district, separately or jointly with the Board of any other hospital district, to establish and maintain institutions such as (1) Consumptive sanatoria, (2) convalescent homes, (3) old people's homes : (e) To cause every hospital to be inspected from time to time. (/) To report to the Government, through the Minister, as to the sums required to be provided from the Consolidated Fund to meet the needs of hospitals : (g) To determine what hospitals should be subsidized : (h) To determine the amount of such subsidies to Boards : (i) To attach to the payment of any subsidy such conditions in respect of maintenance, equipment, and management of hospitals as it thinks fit: (j) To consider and recommend any amendment of existing legislation or proposals for future legislation which are in its opinion desirable. 72. The establishment of such a Board with the powers outlined above should quickly lead to the placing of the hospital system of the Dominion on a uniform and national basis, and we have no doubt that taken in conjunction with our recommendations which follow, the economies which would result would be of considerable magnitude, and would not be confined to relief to the Consolidated Fund by way of subsidy. With a reorganization of the hospital system on the lines suggested, considerable relief to local rates should also be possible. 73. While we have the precedent of a Central Hospitals Commission in New South Wales, a similar system exists in Victoria. We wish to make it clear that the setting-up of a Central Board cannot of itself be expected to cure the ills resulting from the present system. There is no real necessity for the large number of hospital districts which at present exist. We are satisfied that even if so many districts were necessary in the past, and this point we are not prepared to concede, there is certainly no present necessity for forty-five districts, in view of the excellent transport facilities which now exist. 74. Dr. MacEachern, at the instance of the New Zealand Branch of the British Medical Association, some few years ago submitted a report on the hospitals system in New Zealand. This expert stated that he was early impressed with the large number of hospital districts and specially drew attention to the fact that the number had increased from sixteen, as originally intended, to forty-six at the time of his survey. The doctor added that, while perhaps a reasonable increase might be justified, there should not be at present more than twenty or twenty-one, and he went on to state that the multiplicity of hospital districts would defeat the main object of the Act as originally intended —namely, efficiency and economy through the prevention of duplication and the encouraging of centralization. 75. He also stated, and this is a further reason why a Board of Hospitals should be set up, that he found a distinct lack of uniform policy in the medical staffing of hospitals throughout the Dominion. The multiplicity of hospital districts naturally intensifies any weaknesses such as this. 76. Transport conditions have so improved since Dr. MacEachern visited the Dominion that the establishment of twenty or twenty-one hospital districts is hardly necessary. We consider sixteen to eighteen hospital districts should suffice, but do not wish to be dogmatic on this point, and would prefer to leave the determination of the actual number of hospital districts to the Board of Hospitals which we have recommended. 77. The whole subject of hospital administration is bristling with difficulties, and in the time at our disposal we have not been able to examine in detail all the relevant factors which must receive consideration before the final division of the Dominion into a number of districts can be decided upon. Nevertheless, we are emphatically of opinion that the present number of hospital districts is excessive, and should be reduced by at least 50 ; per cent. 78. Each of the new hospital districts should have within its boundaries a town of sufficient size to. enable a base hospital to be successfully established. The reason for this is that it is only in a centre of population that sufficient variety of medical and surgical skill can be obtained to staff adequately a base hospital. The first step is, therefore, an examination of the density of population, the probable trend of development, and the potentialities of each district. Having determined the most

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