N.Z. HOSPITALS.

Press, Volume LVII, Issue 17126, 22 April 1921, Page 9

N.Z. HOSPITALS.

COMMISSION IN CHRISTCHURCH. The hospitals Commission which ha* present touring .New Zealand collecting evidence- relating to proposals for new legation along tho order of reference laid down, opened its .sittings m unrisiohurch yesterday. ~ The Commission is composed or u ; Vernon H. Eced (chairman), Hon. «• H Triers. Hon. A. F. Hawke, Dr. a. ?. RAcland, and Mr G Shjtcl.ffe. There were also in-attendauce Dr. 1. a. A. Valintino, Director-General or Health, and Dr. T. S. AVylie, Director of ihe Division of HospitalsSt. Saviour's Orphanage. Air H. M. Bannelir, eecrctary an-1 treasurer of St. submitted reasons why the K™£ receive an additional annual grant from tho Government. He -aid that Guild for some rears had received ■ £2W : a vcar and it'had .asked\hat an increased grant should be made,, on ac-] count of the increased cost of living and the lar«e number of children cared for in two -homes. The Government had given a grant of £2OO when the Guild Ins housing and caring lor a very few children compared, with the- large minibci- in its care at the present time. The cost., formerly, wa* much lower than it is now, and the Guild lelt that it could justly claim a larger sum than wa« »ivcn formerly. It was'saving tho Government a largo sum of money. Owin-' to the great national work it was doing" and the number of children it, supported educated, and trained to be good, citizens, it was entitled to a grant; in aid. . ~ In replv to tho chairman, Air Bannehr said that last year the voluntary subscriptions, offertories in churches, and maintenance fees amounted to £5918 lis 6d. Tho ofhor item of revenue was the Government grant.-it. £2OO. Children of any denomination were taken .into the institution, but they were brought up as members of the Anglican Church.. . ■ ~ ~ , In reply Tr.iggs, ho said that if by any ehanco tlho Guild could not carry on, many of the children would full back on charitable aid.' If tho Government generally made grants to those institutions on tho recommendation of Education Boards or Hospital Boards, and if those bodies had representatives on tho committees of the. institutions, voluntary contributions would lie discouraged. To Mr Shirtcliffe, ho said that grants to orphanages throughout the Dominion should bo on a capitation basis. Inangahua Hospital Board. Mr Ci Novin, secretary of tho Inangahua Hospital and Charitable Aid Board, Reef ton, submitted tho. following evidence on behalf, of tho Board :--' (1) That the whole capital cost of building hospitals in.the Dominion should be. borne- by tho Government; (2) that a sliding Bcftlo of subsidy, as suggested at tho conference of Hospital Boards, should be tulotjted; (3) that the present rato of subsidy, 24s in tho pound, should be continued; (4) that the Government should, contribute to meeting the <'<>st of separate institutions, as at present; (5) that the question of grants # to charitable societies' and institutions should bo left to the Department to deal with according to the needs of societies; (6) t!hat maximum fee- of £2 2s a wools for maintenance and treatment in public hospitals should •be charged; (7) that it wad not desirable to have private or paying wards in publio hospitals; (8)-that- the .present method of allocation and election by the rfjiepayers was satisfactory and just to all concerned; i'B) tho Board was opposed to Government reprosen* tation on Hospital.Boards by mean? "of nominated members; (9; tlho areas of the hospital districts should remain as at present; (JO) the Health Department should " and store. all necessary drugs and surgical requirements, arid supply' them,to the Hospital Boards-at cost price, all boards to bo compelled to purchase those sup-' plies from tho Department. In reply to Mr Shirtcliffe, Mr Niven said Dliat about one-third of the patients at the Reefton Hospital paid tor hospital treatment, but those who did not pay were followed up and wore urged to pay.

In reply to the chairman, Mr Novin said that if the Inangahua district was amalgamated with the Grey district the administration expenses would be increased, compared wit/h. tlie present total cost of tho two separate districts. •Country Contributions. John Dryden Hall, formerly for six years a member of the North Canterbury Hospital Board, said he appeared to represent the Selwyn, Malvern, Taweta, Paparua, Springs, and Halswell Counties to advocate the adjustment of contributions on a more equhVable basis. He would- bo glad if tlie Commission would give" the opunties time to meet and formulate a scheme for submission. The chai .ian said 1 that opportunity would bo given. . : Mr Hall then presented a statement setting out the claims of the counties. The .method of' representation did not follow taxation; Christchurch had six members " and contributed £18,058, while Selwyu, Tawera, and Malvern had ono member and contributed £5644. If Christchurch paid according to her representation, she would 'contribute £5644 multiplied by 6, or £83,864, while Lyttelton, Sumner, and New Brighton would. contribute £6644, instead of £2117. There 'did 'not seem to be any justice in making country districts provide funds to bo spent by tho city or borough representatives. The present method N of assessing contributions was unfair. The amount of contributions was . assessed on capital value only, and neither followed the representation, nor was it in accordance witK benefits conferred. If the object was to get at the large landowners, who were excluded by the hospital regulations from any benefits in the way of treatment, and to a great extent excluded the urban capitalist, it must bo borne in mind that tho present method also bit the rural worker and small holder, who paid rates and lived under conditions wnich made the hospital benefit he received more expensive than that of the urban worker. A more equitablo way of assessing the contributions would be j—(1) By way of a mean between'tho capital value and the population of the local authorities' area; or (2) -by ascertaining the cost of treatment ner patient in each, .year, and ,cbargnig the local authority with the number of patients treated from the respective districts; or, if the contributions were required in advance, to assess the amount on the number of patients treated in tho previous year, and make any necessary adjustment at theUnd of the year and include it w the next vear's levy. There 'should be Government subsidies for capital expenditure. The establishment of private or paying wards would be supported bv the country people as relieving tho ratepavera to some extent, and providing a pfacb for treatment-for all, and also providing a larger scope for hospital work generally. That would to some extent reduce the amounts required from the Government by way of subsidies, and if it was accompanied by a system of insuranco to. ensure provision for the care of the sick by means of payment of a premium in the daya of health, it might enable boards to dispense with Government subsidies al- • °Mr Tr'iggs asked was not the value of a city hospital greater, than its value from the point of view of the patients treated there. 7Mr Hall said he thought it was. There was the case of the outbreak, spread, and prevention of epidemics, wlien the hospital and staff were avadable, but those facilities would be ot greater benefit to the Pfft to 'i~.iSS town than to the people, of the healthy

country/There had been a trend citywards in this district almost worse than anywhero else. That, to some, extent, was caused' by older people coining from tho country to the city to live, the lack of secondary education facilities which brought the young people to the "city, and the look of an electric current supply. The current for the city was generated in the Selwyn County, but the county itself got nothing of * it. The extent of the drift citywards should be taken into consideration in fixing the country assessments. ■ / •• .' In reply to other questions, he said he agreed that a base hospital was .essential, but his county could ■ have established a good little hospital with iti contributions'during the past ten years. Practically .half the present income of the .Selwyn County went.into hospital contributions. The representation of the counties on the Hospial Board was fixed quite arbitrarily. Apart* from he had no grievance against the North Canterbury Hospital Board, which he considered the "best in New Zealand. There- was no suggestion of cutting adrift ifrom the Board. As'far as he knew everybody in his county had received irhat the hospital had to give, and he had bad «o grievance Respecting the services provided by the. Board. The chairman said that under the new basis of subsidies the inebmd-tax payer would contribute 22 per cent, of the cost of hospital administration. Mr Hall said a larger percentage could bo charged the income-tax pnyot in the towns. He did not recommend tho shifting of the burden from • the capital value of land to the inconie>tax payer, but that as far as tho country districts were/concerned regard should be had to the number of patients treated, and the mean of population. That would provide a more equitable basis of assessment ■for the country. . He thought it desirable that two representatives of the Government should sit on a Hospital Board of the sizo of the North Canterbury BoaKl; The presence 'of those w,puld be or value to the country districts. He would like to see a woman appointed as one o£ the Government members. It waa a difficult matter to secure suitable representatives on the Board for the country districts, what ho wanted' altered was the fiystem of contribution, not so much that of representation. He advocated a generous Government subsidy on voluntary contributions "to hospital funds,., and thero should bo set-.in action some, propaganda on behalf of tho hospitals to encourage private benefactions. At present the general impression was that the hospitals h&4 plenty of money, and wanted nothing. Mr Hall also advocated the creation of a system of private wards, where people who could pay sufficient to return a profit on the working of the ward could enter and receive treatr ment. The class distinction objection was really of no force, and that objection was raised only for political purposes. Tlie llailway Department made the distinction, and nobody objected, for it was realised that tho substantial profit derived from the first-class passengers operated to reduce the fares charged to others. The ideal system was to have three grades at f. hospital, the first for free treatment, the second for those who would paj. the actual cost of treatment, and. the third for those who were willing to pay su«ch fees as would return a substantial profit. Methodist Orphanage. George Bowron, hon. treasurer of the South Island -Methodist Orphanage, said tho institution was established some 6even years ago, and was controlled by a Board of Management under the Methodist Conference.. The institution was more of a children'a home than an orphanage. There were at nresent 45 children in the Home, 19 Boys and 26 girls' the ages ranging from two to sixteen years. Three other

! children were also placed in the' Pre*-, ' byterian Home. The total expenditure was about £ISOO per annum* which included a Government grant of £l° 0 > , and the cost of maintenance only worked out at 12s a week per child. The.: i income was provided by voluntary con--1 toibutions nnd grants. The Government! grant should be based on some pnnj oiple, either a. porpentage on the contributions or a*per. capita" amount on tho inmates. In 1919 the voluntary and pollectjons totalled £950, whereos last year the total was £2OO loss, Whs Board* of Management would suggest a grant of 20 por cent, on voluntary contributions, "• '•'• Private Wards, Dr. John Quthrje, representing thk . British Medical Association, Canterbury Division, said his views expressed the' matured a>od unanimous judgment of the Division. The,' present hasp}™ l system was' th<J product of the Old Country system introduced by the pio- ■ reers and modified by haphazard evolu--, tion, no definite plan of development' being followed. . -Tho present stage was transitional, for'.many of tho hospitals still have a resemblance tQ the charitable institutions of tho' Old Country. That was indicated by the employment pf an-honorary staff, and the reluctance of well-tp-do peoplß to enter a public hospital. Tho proposal now- was that private wards should be established at the hospitals,. where paying patientß would betaken, such wards, to constitute a separate department, but to be under : routed l ' control., The idea was that those wards would take the place of the present" private hospitala and nursing; homes. Hospital Boards should take ever the entire responsibility or ( the cali-e of the sick. That was the only solution of the problem,.and tho plan had wqrked successfully in countries wbiwe Adopted. The small private ! institutions were subject to many difficulties '.from which • the larger public institutions were free. Proper pi"" l * and prober staffs were not available, and medical or surgical crises caused considerable difficulty. A properly developed vjystem would largely pay for itself, anril would ease considerably the present buMon on tho taxpayer. The best medicnl work was done in the largo institutioni*, whereas what went on in the small private institutions never reached tho publio. If tho treatment received ,wu» tho game, the question of the luxury of the surroundings could be left to the financial capacity of the individual potienfa. The institutions, free and stipendiary, should be kept separate, in order to warrant the charge for privacy, out the control would be unified'. ''To Dr. Acland: A compulsory register should bo kept in all maternity, ,homes. A separate wing could bo added to tha private paying hospital, where patients could have their own doctor, and tho assistance, when required, or the resident staff.

To Mr Hawke: The public hospital could be run by a visiting honorary staff, and a.resident staff. Tho private wing would also amtain a resident staff, and tho medic.il men of the' patients' own selection. During tlie absence of the latter the local staff would bo available, if .required. He did not think his proposal would involve a hardship on "the private homes, for at present tho ladies who conducted such institutions were Dot strong in the business line, although professionally quits capable, and these ladies could bo absorbed into the new szhjome, and would' enjoy all 'tho -benefits of superannuation, and so on. To Mr Shirtcliffo: There Mras an increasing tendency to .send maternity cases into private hospitals. A large capital, cost would be involvod to vide rfcw buildings to toko |tho place oil tho present private bftt that would not affect the success of the scheme. There was nt present accommodation'for about 200 patients in private hospitals in this -distrkit. The

medical staffs would bo enabled to give much more efficient Bervioe in tbo larger institutions tb.au in private institutions which were not subject to criticism. There wate no reason why .: Bny grounds for complaints of differential treatment, should* arise. ' ' i To Mr Triggs; The nurses coiud bo changed in the . two institutions at stated periods, bo as to meet any objection as, to the differential treatment* The medical superintendent should, be in control of. both departments, likewise the matron, with a, Bister in charge of the private wing. Pre-pay-ment or fees or tho, insistence on guarantees of payment -wore both objectionable, and the experience of the private homes was tb,nt bad debts were small* He,saw no reason 1 why there should be 'any friction Jjetween the medical superintendent and the visiting staff of the privaija fward.. -If it were possiblo, he would .establish, ft private ward at an infectious hospital, for such would . strengthen" the scheme financially. . To Dr. Acland: Most people who could afford, it" would i? lnd *y P ft y for privacy alone., Abqve tnem would como the people who wore - prepared to pay for greater luxury. , : , The Commission then adjourned till this morning.