H—3l

The fundamental cause of the shortage of physiotherapists is no doubt the relatively rapid growth in demands and the unavoidable lag in training. There were, however, several other factors. Training was unavoidably costly, and commencing with 1950 general provision has now been made for the granting of bursaries. With the operation of massage benefits under the Social Security Act, private practice has attracted numbers of physiotherapists from hospital staffs. It is understood that some action is being taken to keep payments from the Social Security Fund on a more reasonable basis. At the same time the scales of remuneration of physiotherapists employed in hospitals have recently been substantially improved. With these special factors have been associated more general factors, the strong competition from other avenues of employment affecting the age group from which trainees are recruited, the high marriage-rate, the attractions of overseas experience, and the difficulty in some centres of securing board and lodging at reasonable cost or of obtaining other living accommodation. There has been some recruitment from overseas, and with the improved salary scales now in force renewed efforts are being made in that direction. Next to physiotherapy staff, the shortage of certain medical specialist personnel lias been the most serious, notably radiologists and pathologists, who also have been drawn to the more lucrative work of private practice, while hospitals continue to have increasing burdens placed on those remaining in the service. The smaller hospitals (up to 100 beds) in the rural areas are particularly short of junior medical staff, and there are several instances where a medical superintendent in this type of hospital has to carry on single handed and endeavour to supervise all ■departments, including the attention to an increasing number of out-patients. One reason for this situation is a tendency for junior qualified men to apply for and remain in positions in the larger hospitals until such time as they proceed overseas or into practice instead of accepting positions in the overworked rural hospitals. It would seem not unreasonable to insist that medical bursars should be called upon to give : service wherever they are required in their second and third years after qualification. There is possibly a long period of adjustment ahead until a better balance as between salaried employment and private practice is effected. Many of the difficulties experienced in recruiting and holding staff have been due to the restrictions imposed by ecomonic stabilization. Substantial improvements have already been made in rates of remuneration for medical officers, nurses, physiotherapists, x-ray and laboratory workers, and dietitians. Further improvements for some of these classes are regarded as necessary. HOSPITAL DISTRICTS By the amalgamation as from Ist April, 1950, of the six northern hospital districts (Mangonui, Hokianga, Whangaroa, Bay of Islands, Whangarei, and Kaipara) into one district known as the Northland Hospital District, the Dominion has now thirty-seven hospital districts. They range in size from the smallest, Maniototo, with a population of 2,960 and a total maintenance expenditure in 1948-49 of £8,423, to the largest, Auckland, with a population of 366,040 and a total maintenance expenditure in 1948-49 of £1,446,094. No two Boards are alike in the scope of their services. Only one or two can claim to be self-contained —that is to say, almost all of them must look to other Boards for some kinds of specialist services. Moreover, many parts of the boundaries of our hospital districts are merely nominal, and for many patients there is readier access to a hospital of a neighbouring Board than to a hospital of the patient's own district. From time to time it is urged that the number of hospital districts should be reduced with a view to providing more suitable administrative areas. The optimum size is one that, while it gives reasonably rapid communication between the principal hospital of the district and the outlying parts of the district, has sufficient population , and a large enough main centre to justify a fairly comprehensive range of hospital services,

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