N.Z. HOSPITALS.

Press, Volume LVII, Issue 17127, 23 April 1921, Page 14

N.Z. HOSPITALS.

SITTINGS OF COMMISSION. The Hospitals' Commission resumed yesterday under the chairmanship of Mr Vernon H. Reed, M.P. Private "Blocks in Public Hospitals. Dr. 'Walter Fox, medical superintendent. Christclmreli Hospital, stated that after the very lucid statement of Dr. Guthrie an the question of private blocks iii public hospitals, Jie had little to add, except that lie was quite at one with Dr. Outline's evidence. There was always a proportion of patients in existing circumstances who asked if tttev could get a private room,- for \vliieh they we're prepared to pay; the hospital ■•authorities had no liberty in granting such requests. The existing private hospitals preferred surgical cases, because they "required less nursing and less food than medical cases. Witness suggested that the private block in the public hospital should make provision for one hundred beds.. The establishment of such a block would place at the command of patients the advantages of tho public hospital; itwas well-known that a public hospi- ! tal, run on lines like the ChrwtcTuireh Hospital, provided services that could not be equalled in any degree in ouiside institutions; those advantages would bo increased if a private block existed, as the patients in such a blockwould ' require" special dieting and special cooking, 'and this would be adopted in respect of the. patients in the public portion of tho hospital: at present he way of opinion that they were on the threshold' of providing special dieting and cooking in the public hospital. He advocated that the control of the private block should be under tho medical superintendent; and that provision should be made for wards #b accommodate six or eight patients, other wards to accommodate three patients, single rooms, and a few suites for those willing and able to nay for them. He understood that the tees .at private hospitals were about. £6 <>s •per week, and at that rate the Board would have a- considerable revenue from the private hospital block system. As /to the difficulty that' mijrht be experienced in starting the block in the matter of finding funds, the witness cited tho case of Birmingham, where ~ the medical men had found the money and accepted the local authority's debentures; it might be possible, he stated, that local medioM men would each take up £-±OO or £SOO of debentures for the purpose; in this matter he was not speaking as a.practitioner.. To the chairman: Specialists who had been on the hospital staff had resigned, as thev could not cope with the demands "for their services, especially by persons able to pay the (foes of specialists outside the institution. If the Government . provided loans and subsidies for private blocks in public- hospitals, it should bo the duty of the Boards to provide such blocks. He did not think that the establishment of private blocks would cause dissatisfaction amongst the other patients; it would tend to elevate and improve tho public portion of the institution in approximating it to the! private portion, for- instance in the matter of more facilities for relatives to visit patients. - ' To Mr Shirtcliffe: His estimate of accommodation for iOO beds in the private, block was for a beginning; and was not intended to replace tho whole ot tho private hospital accommodation at present available. , ' To Mr Triggs: it was in order to fulfil the wants of ratepayers-who in present circumstances were debarred from using the public hospital that he advocated, the' private'.block 'System, .■:/,■ . '- To:, Hr. Acland: Under the Board's regulations, the hospital was for the purpose of treating the poem'' smaller hospitals under •the-,Board's control the private block, system was in operation, apparently without the Board recognising the fact —the medical officer in charge of these smaller hospitals had the privilege and power of taking his private patients into the hospitals and charging fees. ~; Suggested Economies. Replying to Mr Triggs,' Dr. Fox stated that the Clmstchurch Hospital was. gradually getting out of the strictly contract system for obtaining supplies. He cited the practice followed in respect of the; purchase of drugs, where tfhe dispenser in conjunction with the secretary and himself watched the drug market, and bought to the best advantage: ■ He also mentioned the satisfactory method adopted by the Simnyside Ment* I, Hospital authorities in £he matter, of "beef and mutton supplies, the Mental Hospital' authorities buying their meat at Adcjington yards, sending some •of tlie;'.-animals to the " abattoir ■ and running the remainder on ' tho : farm attached to the institution: something like £I4OO had been saved in one year on the tender price.- Witness though that the two institutions could co-operate in this matter. He did not consider that a central buying board wpuld be an unmixed benefit." Regarding the improvement of tho efficiency of the staffs, Dr. Fox gave lengthy evidence respecting a training school'for members' of the staffs of the auxiliary services—the kitchen and housemaids' staffs* —and quoted from a letter he had addressed, some time ago to Miss Boys Smith, head of' the Domestic Science School, Dun'edin, on the subject. He stated that owing to the absence of training* these staffs were responsible for considerable waste.. The staffs were extremely junior, and as a consequence were not so responsible. He mentioned that at such a training school staffs of boys' colleges and similar institutions could be obtained. The first step would be to get competent lieads, trained women experienced in handling staffs and prepared, jtf necessity arose, "to turn up'their sleeves and show that, they could do the- work." . '.

Dr. Fox desired to give evidence, on the subject of each hoard providing bursaries for nurses, hut the chairman stated that the subject did not come within the scope of the Commission. Dr. Fox whs asked to submit his views on the subject for the information of members. Mount Magdala Home. Bishop Brodie, - as patron of the Mount JVfagdaa Home, gave a statement prepared by the Sisters in support of the continuance of the Government vote of £BOO per annum to the institution—a graiit that they had been informed thb Government would very likely discontinue. - He stated that; the home was a shelter and refuge for girls and women, and in ten years there had been 856 inmates; the average roll number was 220, >and the ages ranged from 18 to 20; they included persons of every creed, and from all parts of the .Dominion.. There was also an orphanage for homeless girls, accommodated in a separate building; the children's ages ranged from two years upward, and the number in the orphanage was 120; the total of girls, women, and children was 340.- The home gave valuable aid to the Government in .providing a refuge for girls that, otherwise, would have to be cared for by direct Government expense; in five years. 180 girls had been -sent: by Government Departments; it was no exaggeration to say that if the Government Jrnd provided for these the, expense would have been not less than. £BOOO per annum; there were nearly forty labouring under great infirmities, and quit© unable to work—one , was - blind, deaf, and paralysed. ThVgrant of £BOO was only.some recognition of the work done on behalf of the Government. A statement of receipts and expenditure for last year showed: an excess of expenditure over receipts of £3400; with other liabilities the. total debit was £6441. -The; cost. ,of> the institution was the huildiug,

.£46.000 was spout, nDdon'land £4OOO. While the Sisters' were anxious to help the Government, the strain on their finances unless they received some enunances. «"»-- • fl Government, couragement trom " lu A. „- _ + y.,, misht prevent-them providing for the cUs sent to them by.the Government ■To Mr Tri«gs: If' tho Government paid the full Tost of **e. maintenance of the cases it- sent to the Home, it wouUbe a" acceptable as a fixedpant. He did not think that the Government would succeed with such cases as went to tho Home, as m this class of won, the nfiuVnce of religion was required: htv had case, that had been in gaols and reformatories, and the Government had been generous enough to adroit that the Sisters had made the mo.-, successful attempts in dealing with them, he thought it would be a ™* ta V r the Government to take on the responsibilitv of these cases without the duect influence of religion. Persons ot all denominations were .admitted, and there was no interference Trtth religion. Dr Valintine: Tins institution is open to inspection by jßcers ot the Department, and has ahffrys.been well ,o Tt rt Mr°Shirtcliffe: He thought that the present system of Government inspection was preferable to supeniaon bV the Hospital Board If the Homo Was subsidised by the Board, it would, possiblv. detrimentally affect tbamount of voluntary subscriptions *>.. the funds of the Home To the chairman: There, is a school attached to the Home, which is under Government, inspection:, the repous have been always satisfactory. To Mr Shirtcliffe: During last year £2713 represented capital expenditure: the actual deficiency on the working ot the Home last vear was £3o© odd. To Dr. Acland: As far as he kfiew there had been onlv eight cases whicn the Home had been unable to deal witn, and the Government sent the persons involved to gaol, _ Bishop Brodie, at the chairman s .request undertook to supply the average individual rost of maintenance per annum of (1) the inmates of the orphanage, and (2) of the inmates of the other portion of the Home; also the amount of capital expenditure in respect of each department of the institution. Friendly societies' Patients. John Burgess, secretary of the United Fmendlv Societies' Dispensary, gave evidence as to the charges made for friendly societies' patients, and .stated that the present charge was based on £SO per annum per occupied bed; the cost per patient per day was Is <d. They would be quite satisfied to pay on the'basis of .the average amount of fees collected by the board' in respect of other patients, 'which' was, last' year,' £49 per occupied bed per annum. There were,affiliated to the ..United "Friendly Societies' Dispensary 5700 town mem bers of lodges and 6G5 country members. Board's Secretary's Evidence W. S.'Wharton, secretary of the 'North Canterbury Hospital Board, gave evidence concerning all the matters 'in tho order of reference. He stated; as regards.Government contributions to capital requirements, that in the event of the capital amount being raised by levy the Government, as an approving partner; should pay 20s for each £ of such levy; if by loan, the Government should contribute £ for £ of the amount repayable, and to be applied to the. sinking fund, arid also £ for £' of the interest; As to the best means of meeting the heavy cost of proposed capital works, his opinion was "unquestionably by loan." Loans, for. buildings should not be for' lengthy, periods—say twenty years .as' a'-maximum; in the Case_ of fever hospitals .and. maternity institutions, it would be .wiser to have them shorter dated. As had been suggested in the past, such buildings should bo only of a temporary 'character, as if might be desirable to re-build at comparatively short intervals; ."In my opinion,"' witness added, '-the ques-. tion is worthy of consideration, as-to whether the hospital buildings for the accommodation of patients should bo of the solid construction appears to prevail to-day, as with tho rapid chaugee in medical and surgical opinion, it may be necessary in the near; future to practically reconstruct, or rebuild, the patients' accommodation. It has been suggested that the future treatment of both surgical and medical cases will bo in the open air,.which! means that buildings i will be. constructed with this object in view." Witness was of opinion that the.. Government should contribute one-half of. the total cost of the maintenance expenditure on hospitals, etc. Failing the adoption of the suggestions of. the conferenco of Hospital, Boards,, whereunder. Boards accepting thie full responsibilities cast upon tbem would receive adequate assistance from ;tbe Consolidated Fund, be was of opinion that tbe system of subsidy' under the 1885 Act, allowing .subsidy of 20s for each £ of levy would be more equitable than tho . system which had operated during the last eleven years. As to the extent 'to which the Government should make grants in* aid of various charitable societies and institutions, witness referred to the danger of overlapping, resulting in much money being spent unnecessarily: if grants were' to be made to such societies, v they should bo made through the Hospital Board of the district, and then only after the approval of the •Minister had been obtained. He admittedV that the Mount Magdala Homo and the Salvation Army Mission- were doing good work; as regards the orphanages, He stated that as the result j of their activities the Board was being* called upon .to deal with fewer children.

' Mr Wharton's evidence was not eoh'cluded when tihe dinner was taken. _ . ■' ' i. On resuming, it was decided, for the convenience'of the witness, to take the evidence of Mr Watt, jvshburton. Ashburton. Hospital. u Frederick William W'att, a .member of the Ashburton Hospital Board and of the Ashburton Borough Council, submitted a written statement giving the Board's views on the various' matters on the order of reference. The Board considered that the Government should contribute towards capital* expenditure £ for £ to country hospitals, and 24s in tho.£ for Auckland, Wellington, Chns>ehureh, and. D-unedin city hospitals: there should bo a flat rate of 20s in the £ for maintenance: no alteration in the present subsidy on voluntary contributions : the Government Should take over all sanatoria and. maternity homes under the control ef hospital boards at the present time, and contribute £ for '£. towards separate institutions.. Regarding private' blocks in public hospitals,, the Boardwas opposed to it, and considered a sliding scale of fees would achieve the same financial result as. the scheme-suggested by the 8.M.A.; it would also obviate difficulties connected with the management and control of the .hospital: it was considered that the entry of private practitioners would lead to staff difficulties.

Dr. • Valintine pointed out that -ho scheme emanated in the first instance from the Department, and not 'from tfo»s 8.M.A., which body, howfever. sunported it. . i Witness further stated that ihe Board had • been informed ±hat tiho B.M.A. was a trades union, looking after its own members, smd ihe Board was'not likely, unless it was a matter, of law, to have anything to do v. ith such a 6cheme as that placed on the order paper: the* Board objected to outside private practitioners practising in the •Hospital. The Beard provided private wards as well as public words:;, in respect of tho DTivate wards, a slightly higher fee was charged; the nursing and service were the same: he believed that -the fees for private wards were paidhe imagined that those who occupied the private wa.rds were better payers.' Mr Sbirtcliffe pointed out that the Ashburton Board collected only a litnle over 10 per cent, of fees. The Christ - church Hospital, which was available only to tihe necessitous poor, collected £49 per' occupied bed, while Ashburton collected £l9 vex occupied bed.

The witness admitted that this showed that" -there was- something-wrong with tho system of collection. What steps have been taken to consider this question?— Practically none. Are members not interested*?— Yes, they are interested, but the matter has never been brought under their notice. The Board has gone rather far in providing cheap medical service through the non-collection of fees?— Yes. Replying to Dr. Valintine, witness stated that a child recommended bv the school medical officer for treatment was refused treatment at the hospital not on account of the diagnosis, but on account of the capacity of the child's parents to pay for the treatment of the child in a private hospital. Administration Matters. Mr Wharton, continuing his evidence, stated that the fees .charged patients for maintenance in public hospitals should be such ns would cqver the total cost of maintenance. Before patients were admitted enquirv was made as to their financial position, and if, on the face of it, .they'were in. a position to meet the charge of treatment outside, then admission was refused.. Witness, was of opinion that it would be a. sound proceeding to open private or paying wards in public Hospitals : lie did not favour if the Board were given authoritv to establish such wards it would be sufficient to induce other Boards to provide similar wards. The present method of electing representatives to the Board appeared to be satisfactory except that the different methods of voting in boroughs and counties appeared to act unfairly in the case of combined districts. He didj not favour tho appointment of a nominated'-member on hospital boards. Referring to the question of hospital districts, witness favoured such districts being co-terminous with the health districts. As to how economies can be, effected, witness said that Boards have every . opportunity for purchasing supplies, from wholesale houses or manufacturers. He cited instances iin which the North Canterbury' Board had landed cotton, goods in it's store at one half tho cost that they could have been obtained in i Christ .church; and exhibited a plate, and stated that tlie Board bad', landed' them at lis per dozen, flio local.price, being ?2s per dozen. Ho also cited several; instances %i lower I prices of drugs ; imported direct, as compared with local prices. i The Commission rose till 10* o'clock this mqrning. ,