H—3l

OUT-PATIENT SERVICES In this phase of public hospital activities we have also witnessed great changes over the past ten years. Almost throughout the history of our hospitals the out-patient services have continued to expand both in the number of patients and in the range of service. The introduction of social security health benefits influenced the position in various ways. The operation of benefits in respect of general practitioner services tended in some degree to reduce the attendances in out-patient departments of the general medical and the minor casualty types ; but against this the fact that specialist and other services provided at public hospitals became free of charge to patients gave rise to greatly increased demands. The past decade has witnessed the very considerable development of specialist clinics of various kinds (tuberculosis, cancer, rheumatism, eye, ear, nose, and throat, obstetric and gynaecological, orthopaedic, neurological, cardiological, &c.) ; x-ray diagnostic and treatment - services, and physiotherapy services for out-patients-have also notably increased. The total number of out-patients of public hospitals for the year 1948-49 was 535,681 and the attendances 1,264,669. The respective totals for 1939-40 were 172,000 and 569,128. In addition, dental cases and attendances were respectively 26,777 and 63,537 in 1948-49 and 34,023 and 77,581 in 1939-40. The introduction in 1946 of benefits in respect of laboratory services has also greatly increased the demands on laboratories attached to public hospitals, which provide the major part of laboratory services. In respect of x-ray, physiotherapy, laboratory services, and certain of the specialist medical services the demands still exceed the capacity of many of the departments concerned. STAFFING Although closely comparable figures are not available the changed picture of hospitai staffing in the past ten years is broadly indicated in the following figures as to establishment of paid staff of public hospitals :

Table 21

Reference has already been made to the special problems that Hospital Boards have had to contend with in relation to staffing during the war and post-war period. The position in respect of nursing staff is reviewed in the annual report of the Director of the Division of Nursing. While an abnormal turnover and acute shortages still persist in various other classes, one of our most serious difficulties has been, and is, in regard to physiotherapy staff. It was most acute following the poliomyelitis epidemic, and it is still unfortunately impossible to provide essential physiotherapy for large numbers of patients. The estimated minimum establishment of physiotherapy staff of Hospital Board and Health Department institutions is 188 whereas the number employed is about 115.

40

At 31st At 31st March, 1949. March, 1940. Medical (whole-time and part-time) 820 346* Nursing 7,463 4,156 Other professional and technical staffs 960 381 Indoor domestic 4,461 2,662 Outdoor and maintenance 1,101 520 Miscellaneous 663 264 15,468 8,329 * III addition, there were at 31st March, 1940, approximately 190 honorary medical staff who were shortly afterwards placed on a paid basis.