BIG SPENDING BY HOSPITAL BOARD

Press, Volume XCV, Issue 28261, 26 April 1957, Page 15

BIG SPENDING BY HOSPITAL BOARD

Cost Expected To Be

£2,650,571

An estimated expenditure of £2,650,571 for the current financial year was reported at the annual meeting on Wednesday of the North Canterbury Hospital Board. The amount is an increase of 11.2 per cent, on the estimates approved last year. The division of the expenditure is:—maintenance, £1,725,019; capital, £273,393; loans, £652,159. This year the Government assumes the entire responsibility for hospital finance; “and the national character of the hospital service becomes complete,” the board’s executive officers commented. They were complimented on the expedition of the presentation and fullness of the budget.

“While the last year has seen a renewed upsurge in spending, I am confident that the budget is realistic, and that the amount asked for is the minimum necessary for the efficient carrying out of the board’s responsibilities,’’ said Mr L. Christie (chairman of the finance committee), presenting the financial statements. This year there was no contribution from local authorities, almost all the money coming from the consolidated fund.

In 1939 maintenance expenditure was £245,431, towards which Government subsidy contributed £81,621 and local authorities, by way of levy, £82,634, said Mr Christie. The last figure was very interesting because it represented the days of the £ for £ subsidy, when local authorities bore a full share of the costs of their hospital system. The full amount contributed by local authorities that year included £94,142, or a rate of approximately l-3d in the £ of rateable capital value. For 1956-57 the rate was l-12d in the £l, and the amount realised £68,371. In the space of 18 years the rate was reduced 400 per cent., but the amount collected fell by only 138 per cent. Mounting Expenditure

Taking the maintenance expenditure in 1939 as 100 the comparative figures each three years to the present day were:—l942, 150; 1945, 185; 1948, 275; 1951, 384; 1954, 557; 1957, 655. Expenditure had increased six times and a half. The reasons for that were manifold inflation generally, shorter working hours, increased salaries and wages, more staff in the highly skilled professional and technical groups, and last, but not least, greatly expanded services. Since 1937 the population of the board’s district had increased from 178,550 to 242,471. That, in itself, had brought many problems, and was one of the basic factors necessitating the new Cashmere Hospital. “We can now turn to the current budget, and consider it in the light of this general background, realising that the very large sums of money which we propose to spend are the minimum needed for an adequate and efficient health service for the people of this district,” said Mr Christie.

Mainly because of the amendments to the Hospital Employment Regulations, authorised last October but effective from the previous April 1, £79,274) more than was estimated was spent on account of maintenance. That extra money came from the following sources:—Receipts greater than estimated, £21,517; advance of subsidy, £55,000; book overdraft, £2762. _ Very sensibly the Health Department had now ruled that such advances need not be brought into the following year’s accounts and the advance therefore became a supplementary grant. The bulk of the overspending occurred in hospital maintenance which accounted for 86 per cent, of all maintenance expenditure. The deficit would have been higher had not it been for the exclusion from the accounts * of March invoices paid in the first week of April. More Maintenance “For next year even more money will be required, the net increase for maintenance being £114,533,” said Mr Christie. The increases, which were greatest in hospital maintenance, were fairly general throughout all accounts. This was in part caused by the change of accounting system. The estimates had been conservatively stated and account had been taken only of known increases or those which were sufficiently definite as to warrant inclusion. No provision had been made for the occupancy of the Fresh Air Home which it was hoped might be in use within the next few months. In spite of a reduction of the capital account programme from £264,978 to £lBO,OOO only £108,206 had been spent. Although every effort was made to carry out the whole capital programme, difficulties and delays arose from a wide variety of causes. It was for this reason that a lump sum reduction of the programme was made each year. This method was a flexible one, making financial

provision for what might reasonably be done, but leaving a wider range of projects to choose from. The capital programme for this year was £252,960, comprising some 413 items, but the amount that it was judged would actually be spent was £160,000. Appeal for Loans

Loan funds, which were the board’s own responsibility, were raised from the open market, the last public issue being £450,000. With that sum, a further £lOO,OOO raised through brokers, and £104,000 carried forward from last year the loan programme was able to be carried through without any financial impediment. Expenditure was incurred on eight different building projects last vear, the total amount spent being £439,189. Next year provision was made for 11 projects involving the expenditure of £652,159. That would require the raising of further loans.

“We are confident that the public of North Canterbury will support these loans and enable the development of Cashmere and Burwood Hospitals to proceed as planned,” concluded Mr Christie.

EXTENDED SERVICES

Special Work Develops

“Although the cost an occupied bed a day in the Christchurch Hospital has trebled during the last 10 years—from £1 Is 3d in 1946 to £3 3s lOd in 1956—it is satisfactory to know that the cost of maintaining an occupied bed there is the lowest of the four metropolitan hospitals for approximately similar services,” said the chairman (Dr. L. C. L. Averill), seconding the motion for the adoption of the estimates at the annual meeting of the North Canterbury Hospital Board.

“Although the costs of providing hospital service are increasing with each budget, it is important that the extensions of our hospital service in the North Canterbury area should be realised,” he said.

Beds available in the board’s institutions were: medical, surgical, maternity and geriatric, 986 beds in 16 institutions; tuberculosis, 236 beds in three institutions; old people’s homes, 223 beds in two institutions; children’s home, 34 beds in one institution; a total of 1479 beds. In addition, there were 32 beds at the Fresh Air Home, closed at present, but which would be put to good use in the near future.

During the year, 18,792 patients were treated in these beds (representing one in every 13 in the North Canterbury hospital district) and there were 138,933 attendances at the Christchurch Hospital Outpatients’ Departments. By comparison, in 1939 the number of in-patients treated was 11,661 and the number of outpatient attendances 46,038. There were 24 different outpatient clinics and these were expanding both in number and volume of work each year. The latest to be established was one for the treatment of alcoholics. “There have been tremendous developments in the special services such as X-ray, pathology, radiotherapy, physiotherapy, and others which make possible the application of newer methods in diagnosis and treatment,” said Dr Averill. “One instance is the installation of the theratron unit, a gift to the people of New Zealand, and the first cobalt therapy unit in the country.” Modern Anaesthesia

All the clinical services showed considerable development over the last decade, said Dr. Averill. One example was the development of modern anaesthesia. From bottles of anaesthetic given on an open mask by any young graduate, they now had a team of specialists employed in the institutions with much expensive equipment and cylinders of different gases. The patients had benefited greatly by safer, more pleasant anaesthetics, and operations could now be performed safely on patients previously considered unsafe for anaesthetics.

Since 1939 the population of the hospital district had increased by 63,921, which meant that the board had to provide hospital services for that extra number of persons. Also the greatly increased number of vehicles of all descriptions on the roads and the greater mechanisation of industry and farming had added to the accident rate for which casualty services had to be provided by the board. “The board will continue to provide the best service possible for the people of this hospital district, but the cost must necessarily increase,” Dr. Averill concluded.