HOSPITAL LEVIES
PROTESTS AND REPLIES . CONFERENCE CONSIDERS POSITION IMPORTANT SUGGESTIONS BY THE MINISTER
.A conference called by the Minister of Public Health (tho Hon. G. W. Hussell) to consider protests mado against tho levies of tho Wellington Hospital Board for the current year was held in tho board's offices yesterday. The Minister presided, and thero were present members of the Hospital Board and representative.-) of the contributing local authorities. The delegates represented the following bodies:— Wellington City Council, the Mayor (Mr. J. P. Luke, M-.P.); Miramnr Borough Council, Mr. P. Townsend (Mayor) and Councillor S. Underwood and the ongmeer (Mr. Pox); Eastbourne Borough Council, the Mayor (Mr. P. Levi) and Councillors Marquis and Morris; Johnsonvillo Town Board, Mr. It.- Bould; lower Hutt, Councillors A. Hobbs and M'Dougoll; Petone Borough Council. Mr. J. W. M'Kwan and.Councillor Cox; Upper Hutt Town Board. Mr. A. J. M'Curdy; Hutt County Council, Councillors AV. Gal]owny and W. C. Cooper; Karori Borough Council, tho Mayor- (Mr. B. G. H. Burn) and Councillor J. AV. Henderson. »
Tho Minister, in opening tho proceedings, said that medical science had enormously improved during tho last ten or fifteen years. Now services and new' methods had beon introduced, and had been adopted in the New Zealand hospitals as far as was practicable. All this had involved capital expenditure. He had looked carefully through the objections made by the local bodies to tho hospital .-levies. He could say that be inad always recognised the necessity for duo economy, in hospital administration, but he would not allow economy to'standin the way of. efficiency. The increased expenditure on hospital administration had not been borne entirely by the contributing authorities. Tho Government's contributions had increased steadily, as the following-figures would shiw:—l9ll, JM.OCO"; 1912, ,6169,000:.-1913. ,2192,000; 1914, ,£195,000; 1915, .£213,000; 1916,- ,£228,«00; 1917, .8230,000;-1918. .£243,000. AVhen he became Minister of Public Health, ho Siad looked carefully into hospital financo,' and one of- his-first recommendations bad been that in- order to ease the burdens of the local authorities the hospital boards should borrow instead of levying for capital expenditure.- He did not know just how far the AVellington Board had followed this policy. The following figures .showed tho levies mado by all the hospital boards for capital expenditure Jn tho years named:-1914-15, .£56,000; 1915-16. .£36,000'; -1916-17. ,£38,000; 1917-18, .£37 000; 1918-19, ,£50,000. He considered that the borrowing.of money for capital expenditure was entirely.justifiable, since posterity ought to-pay a. share of ..the cost of, permanent works and improvements. Preferring, .to .'the objec-'! tmns made' to' the AA'ellington Hos-! Jiitnl Board's, levy,- he must agree! that the basis.'of-the subsidv was in- ! equitable. Had the war not, 'intervened i proposals, would havo beon submitted to i Cabinet already for -an amendment of | the system.. The allocation of tho sub- ' sidy..was not equitable. He hoped that: during .the, next, session.tho rule Jaid down by tho Government against legis-1 latum not directly connected with the) •war would be relaxed. Tho present' position .'was' that the Auckland Board received a subsidy.of 19s.'3d. in the pound, the Wellington Board 16s. 3d., the Dunedm Board -195., 3d., and the Christchurch Board 14s. 3d. He considered, that 'all tho city boards at. any rate should be placed on the same footing. The .question of 'the constfc". tiitionnf tne boards' was a matter on which the conference would bo entitled to express an opinion. Any resolution K adopted would bo carefully considered by tM Government. He considered that in the allocation of subsidies generally - the poorer districts should receive, the higher-subsidies. Tho Auckland rate -was With- of a -penny and 'the •uellmgton and North Canterbury rates were \ of a penny:. He believed it to be a sound principle, that the subsidy should vary in proportion to the Xate, 3n order to afford relief to districts that, wero heavily burdened. ' The Minister referred to the suggestion that the Wellington Board had failed to collect fees from patients -able to pay. The figures showed • that the Wellington Board had done better than most other Boards iu collecting fees that were receivable. Ho had strongly urged tho boards to mako a more active effort to collect fees from patients who were able to pay. No man who could afford to pay should be allowed to escape, though easy conditions of payment should bo allowed. If people who could pay did not do so, the boards should have no mercy. Tlvey. should tako the cases to the Courts. ' Delegates: What will' the Magistrates no ? ' \ •;Mr. Uussell; "I must .assume that the Magistrates will do their duty." He considered/that tho boards should push claims for fees even after a lapse of years in cases-where peophV could afford to pay. • The boards should' employ collectors. ', It was true that the cost per bed was higher in the ■Wellingtou Hospital than in sim-
il.ir institutions elsewhere, and that was a point worth consideration. It might be found that most of the difteronco would disappear ii ' the accounts were analysed on the same basis. ■Iho Minister referred to the increasing cost of living, which affected hospitals as well us private homes, and urged that every hospital ought to have a iirstclnss business manager, to direct the business side of the institution in direct touch with the chairman, ouch a man probably would be able to save his own salary several times a year. In conclusion the Minister' suggested-, that tho Wellington Board should try to increase the sum received by way of voluntary contributions. North Canterbury hail consistently received several thousands of pounds a year by way of voluntary contributions. Hawke's Bay raised som'e .£7OO last year by means of a "Hospital Saturday." These contributions carried a Government subsidy "of 21s. in, the £. But the Wellington Board-had received last year only JC7I from voluntary contributors.
Wellington Council's View. The Mayor of Wellington thanked the Minister for calling the conference, and moved a vote"W thanks, which was carried without dis'cussiou. Mr.' Luke said that l)e was not i.-ostile to the Hospital Board, but lie thought that the conference, ought to consider the peculiar position in which the board stood. It had the responsibility of administration, but it had no responsibility to the ratepayers for linauce. The members of the. board, under these circumstances, did not have the keen regard for economy that they would bavo if they carried a direct responsibility- to the people who found the money. He ■did not believe it would be a good thing to have another rating authority in the city, but the position would be improved if the council, which bad to find tho money, had its representatives on tho Hospital Board. Mr. Luko quoted the official figures to show that the Wellington Board had collected proportionately less in fees from patients than other large boards. If the Wellington Board had collected more money the financial position would have been a great deal better. ■ Mr. Baldwin (chairman of tho Hospital Board) said that the board had 150 case* in the x hands of its solicitors. Mr. Luke said that in ten years tho population of Wellington had increased 15 licr cent., and the hospital expenditure uad increased HO per cent. _ There.had been.a continuous increase in the levies made-by-the board, which, during the last year, hnd piled up an adiridonal debt of £8000. duo by patients. \ Mr. van Stamen: Would you like us sue the poor people-who received hospital'treatment—the peoplo earning .£3' a week? "-■■■ I ■'-.■. .'. Mr. Lilke said that Wellington w;as a large seaport, and the basis of contribution was wrong; The subsidies and the' system of representation were all unsound. The general opinion was that people who ' earned a great deal more than £& a week had been allowed to receive hospital' treatment'-without payment. ' A Hospital Board member: No. Mr.' Luke advocated a return to tho collegialo system of election, in order that the contributing authorities might have direct representation on the board. The present system was producing burdens that were too heavy to be borne. ■ I Petone's Protest. Mr. J. W. M'liwan said ho agreed that an efficient and' well-found hospital was essential. But economy must be exercised in this branch as well as in every other branch of local administration. The board's levy on the Borough of Petone had increased by -75 per cent, since 1514-15. Air. M'Ewan proceeded to analyse figures to show how tho board's expenditure had grown. ,The cost per occupied bed in the year 1914-15, including all items of expenditure, had beon .£l2B (is- Bd. The corresponding cost this year, according to his calculations, was .£l6B, or £3 Is. a week. • The board charged Xl' 2s. a - week for civil patients and 80s. a week for military,! patients. . The cost of treating soldiors in the llotorua Hospital was 355. per week. AVhy, then, did it cost the Wellington Hospital Board £& 4s. a week to treat patients? .He.was a member of the board, but he had voted against its estimate-.
*Mr. Baldwin said the cost par bed in 191(5-17 had boon JJ2 to ill pov week. Mr. MTSwan's estimates of this year's coat were not sound; siuce this year's expenditure bad not yet been ascertained. XTr. M'Ewau pointed to a largo increase in the board's meat bill. He was. convinced there was something seriously wrong in this respect. Tho increases in the cash.prices of meat since tho outbreak of war had not heen large, yet the- cost of moat per occupied bed seemed to havo cone up about 100 per cent. The board's oill for butter and egga had. been double 6inco the beginlnm? of the war, yet everybody knew that the prices of these articles had not doubled. Turning, to (he receipts sido of the accounts, he found that the board was estimating on. the basis of a reduction of normal receipts from foes, etc., when the experience of past years had been that the receipts showed a gradual increase. It would be reasonablo to ask the board for a Teduotion of at least J3IOOO in its estimfltes on aoconnt of economies that wore being effected, and of another .£IOOO on account of the un-(lor-estiinato of receipts-. This would afford somo relief to the contributing authorities. Then if the Government, would agree to pay an increased subsidy the -authorities would be relieved of about ,£SOOO.
Mr. Tan Stavercn urged that this line of .argument had no proper bearing on tho matter under discussion. The law would not be altered to affect this year's accounts.
Mr. .Russell said that ho thought Iho discussion should bo full, H 0 wished to hoar the views of the local authorities Mr. M'Hwan- moved: "That this conference urges the Hospital. Board to reduce its levy by .£IOOO, and that in order ; to assist the boaTd the Government be asked to grant a subsidy on a £ for ,£ bains.-" He said that an alteration in the law to make possible this subsidy could be restrospective. The motion was not seconded.
-Mr. Baldwin said that the complete figures showed that the'board expected to collect iEd'OOO more in reps' (his year than last year.
Increase's Explained, Mr. 3. Castle (Hospital Board) said (hat it was true that the levies had increased at a greater rate than the hospital expenditure. This was due to tho withdrawal of Horowhenua. Tho increase in the levies had been about 70 per cent, during tho last five years. The net estimated expenditure of- tho -boaid had increased about 45 per cent, in the same period. But tho Horowhenua district, which had contributed 12} per cent, of tho rateable value of tho board's district, bad separated, and its share of tho cost had to be added to the other districts. That had boon tho chief factor iu the increaso ; shown by this year's levy. Another'fnc- ; tor had been n fall in the rate of subsidy of about 2s. in the £. Both those I factors were entirely beyond the control of the board. Mr. Luke: What is the net difference caused by Horowhenua ? Mr. van 'Staveren: ,£.'1700. That' is net, after the' Horowhenua expenditure- has been taken out. Mr. Castle referred to tho growth of (ho institution and the increase in tho number of occupied beds, If his estimate for this year was realised tho ircreasa in tho number of occupied beds for the last four years would be 25 per' cent. Probably the estimate would be exceeded. Tho prices of all'materials used by the board had increased. The increase in the board's expenditure during the period had been about £27,000. The increase in the cost of meat to. the board was about 50 per cent. The prices wero Bd. per lb. for mutton, against 5d.; and 9d. for sirloin of beef, against 6jd. ' A delegate: You are paying above market rates. . Mr. Castle: We have a contract. AYo called for tenders, and got one tender. A delcgtite: They : knew it was a t'reo and easy board.' 'Mr. Castle said that 40 per cent; increase in the prices of materials would be a fair estimate. The Government Statistician estimated that the cost of foodstuffs in Wellington bad gone up. 38' per. cent, since 1914. The board wn-s a largo ÜBer of drapery and hardware, which had increased .in price as ' muoh na 200' 'per ceiit. Unscreened coal was costing the board 2.75, sd. a ton, instead of' 195." Odi Ho estimated that tho general increase in.the.prices paid by, the board was hot less than 40 per cent. Tho board spent .£16,000 on materials in 1914, nnd if they allowed'for 25 per cont. increase in consumption and -40 per cent, increase in price, tho increase in this year's expenditure over 1914 would, lie .£BOOO. Mr.' I Castle said that the board was spending over i£looo this year on capital account, and wns meeting increases in interest and: sinking fund charges amounting to MM, owing to tho erection of tho fever, hospital and other works.. The increase in tho cost of charitable aid since 1914 had been over '.£I3OO. and (he war bonus to- the outsido staff cost .£llOO. The Convalescent Home at Belmont was a new charge, and so. was the Hilary paid, to tho officer in charge of the X-ray department. Tho Minister said that the Department's figures showed that the board had lost JJIB7I net by tho elimination of Horowhenua. Mr. Castle said the Otaki Hospital had gone, but the hoard had to find X9OO for tho maintenance of consumptives'. Then the salaries of nurses and tho wages of domestic' and outside workers had"been increased by about 15 per. cent. The figures and percentage- increases ho had outlined gave an increase in expenditure •sinco 1914 of .£28,500, while the actual increase had beon. about .£27,000.- . . The conference adjourned for lunch,: and continued tho discussion in the afternoon.
' Mr. A. E. Budd (Onslow) said tho opinion of his council was that tho whole of I ho hospital' charges should be paid from , tho Consolidated Fund. It would have full confidence in Government control t'f [ the hospitals. Ho felt that as tho o\st , per occupied bed was over .£8 per week, the board should not be content to charge [ patients only £2 2s. per week. Soldiers . were being treated at' a heavy loss, and [ with business administration an improv; ed arrangement would bo made on this , point. It was no reply to eay that poor . pcbplo could not pay £3 a week. Poor J people did not pay anything at all, and plenty of tho patients wero in a position \ to pay the full cost of treatment. The contributing bodies wero not. antagonistic I to the board, but they felt .that fuller information was required regarding libs- : pital finance. j Reduction Proposed. 1 Mr, Luke, whd stated that ho had to ■ leave the conference, moved: "That this conference requests the Hospital Board to reconsider its tsti- ■■ mates, and mako'a reduction in accord-ance-with'the representations of the local bodies, provided that any such reducibu shall not impair efficiency in mainten- " ance." Mr. Baldwin: I can say at onco that the board cannot cut down its estimates "vithout impairing efficiency. It is quite ossible that we may bp ablo to s;.-ve bout £$Mj under two headings now being usidered, but the board cannot cut its •'estimates down, and maintain the efficiency of the institution as at present. Mr. Eussell said that the Defence De- . parhnont paid for its own doctors, orderlies, and clerks, so that the charge made for military patients could not be com- . pared directly with the charge 'moosed upon ordinary patients. Tho Minister pointed out that the .cost per bed in tho various hospitals year by year eculd not be compared without consideration cf various factors not disclosed by the figures. Mr. Baldwin's Statement. Mr. Baldwin, in reply, said that this year's levy' exceeded last year's levy by •£5803. The board was losing this "year at least .02929, owing to tho separation of Horowhenua. It had to meet automatic increases in salary amounting to .CIOOO. The instalment of a new X-ray 'apparatus had been a necessity, and had involved the engagement of an expert at a. salary of a year. Another export had to bo engaged temporarily at a salary of .MM p. year, pending tho arrival of the first expert, who was coming from the front with- the latest knowledge and experience. Mr. Baldwin quoted other items of increased expenditure, and said they explained fully the increased lovy. It should be remembered that tho normal increase had been accentuated by tho withdrawal from the district of Horo- &*«» lateable value of about ■U.0W.000. The fees receivable lust year had been..£33,000, and the amount actually collected had been .£5863. At the close ot tho last linaucial year tho Defence Department Jiad owed tho board ,£IBOO. Delegates pointed out Hint tho item did not appear in the board's estimates. Mr. Baldwin said lie had only just heard of the item. A dolegalo: There you. are! You don't know where you are! Mr. Baldwin admittod that the charge for salaries was higher in Wellington than in Auckland. He was not satisfied that a reduction in l!io charge could not bo made. But tho Auckland Board did not chavgo to the general ilem of salaries all the items placed under that heading by the Wellington Board. Comparisons wero unfair unless the districts were all working on tho same system. A. dolegnts: Why does not the Department standardise tho accounts? Mr. Baldwin: "I don't know." The stoppago of the work done formerly by the St. John Ambulance Society hud involved the board in henry expenditure for the provision and maintenance of ambulances. Three drivors had to be .employed. Tho loss under this heading was about J;o'fHt a, year, but efficiency required tho use of motor ambulances.'The local bodies had hot proved that tie board's estimates wero oxecssivo, jind lie considered that the increases were justified by the facts. The board's expenditure undoubtedly had increased, and it would continue to increase. Tho Hospital was an institution that bolonged '
fo tlin people, and ii: was paid for In- the people through (lie Talcs and laws." A doli'giilo: Make (ho patients rav more Mr. Kahliviii: "Tliev will hot' pay more. You can't make lliom." People had not the dmul of hospitals itat prevailed many years ago. The uospilals were becoming- popular. Tlio people realised the value of these public institutions. The hoard demanded payment from every patient. Failing a response, all tho debts were placed in the hands of tlio solicitor, and visits were paid bv the collector. When a debt was written oil' tlin booh.? iho board did not nbandon its rights. Tho debt was still duo to the board, and as a matter of fact fees were sometimes collected after tho passing 0 f years. When a jiatient came from an outside district tlie board tried to collect the money from another board, but in any case tho cost of hospital maintenance would continue to rise, and the day would come when the camel's back would be broken. Then another arrangement would be made. Mr. Baldwin expressed tho opinion that the board should not bo required to pay for the maintenance of children committed to State institutions. Wellington had to pay for 315 suoh children in l!) 17, at a cost of I'oldJ, and as muflh as Auckland, (.'hristchurch and ]) u nod in put togellier. The cause of this was the dumping of rjiildren on the' Wellington district. The local authorities should support any proposal for placing tho full responsibility for such children on the State. As for the board's expenditure generally, tho induction of this year's estimates would mean merely that the exnondiluio wouldi have to be undertaken in another year. It would bo a very great mistake to 1 evert to the old method 'f electing hospital boards, and it.would be a bold Government that proposed to. lake from tho peopie the right of deciding who should control tlio hospitals. It was true that tho salaries paid by the board hud increased, but the same could be paid of every public body. Mr. Luke: Wo are not opposing the increase of salaries.
Mr. Baldwin soid the point had been raised bv I'etone. lie believed it was impossible for the board lo curtail its estimates without impairing tho efficiency of tho institution. The members of tho board had done their best all along to prevent unnecessary expenditure. But it was not possible to economise, severely in a public hospital. The Minister's Suggestions. Tho Minister said the figures placed before him by the board showed that the actual incroa.se of the board's levy was ,£SSQ3, and' the burden on the local - bodies was uiado larger by the with-' drawal of Horowhemia. He had called the conference in the hope that tho difficulties between tho various bodies might be cleared away by full and clear discussion. Ho Had come to get information; Ho had power to appoint a commissioner to go into the .whole business, but hp felt that a commissioner, would get no mora information thaii had been placed before tho conference. He belioved that there was room for a great deal of impiovoment . in,, tho Wellington Board's administration. Tlio returns prepared by the board were not in Ms opinion or in the opinion of his Department satisfactory; Sonio time ago regulations had been prepared ronusririg all hospital boards to keep their books on the same basis. Tho figures would then provide a fair basis for comparison. He hoped it' was not the rule of the Wellington 'Board to abandon claims against people who had moved to other districts. 'Ehero was room for co-operation among the boards in this respect, and the matter might bo considered at tho next Hospital Conference. Hn felt that there, ivns room for a. great deal of improvement indeed with rogardto the collection of fees by the Wellington Board from the people who : had been inmates of the hospital. Last year tho fees payable by these people, amounted to ,£32,000. the foes actually collected from these people amounted to .£7400, to which had to be added a sum of .£3600 paid by the Defonce Doparlmont. That return was notj a fair result. A sum of jC37,000 of unpaid foes was owing to the board nt the present time. There was room for bnsinessliko methods in' 'dealing with such a. large sum, and as a Minister he was .interested.
A delegate: Ton will have to get tho Magistrate's Court procedure altered. It w very difficult to prove that a man is able .to pay.
ih: Kussell! That is a matter, for the board and its officers to deal with. In my opinion a fair proportion of this money should bo collected. Then the burden on tho rates and on the Consolidated ,Fund would bo reduced
Business Manager Needed. Eussell said ,ho-felt strongly that the board should hnvo a biisiness mauTW ltl ! ? cleftr definition of responsibilities Jietweou the medical side and the business side. Ho had carried out ■ that system in the Health Department, and ,hei intended to go further. He was going to a,sk Cabinot to authorise 'the appointment of an inspector of. hospitals whose duty would be to inspect hospitals from the, business side just as tho medical officers inspected them from the S Sd °' v le , ¥Mt kDOff what methods were adopted jn the buying, tho handling and .tlio distribution of rijwaidmtttaub.by the Wellington S? i•i B m , ho , 6U K est «! that the board should develop an improved organisation The cost of patients in the mental hospitals was about ,£26 per head per annumft as against 4100 in the public hospitals. The comparison was not altogether fair sinco tho mental hospitals had productive farms But there was room for improvement in tho public hospitals. After suggesting that the board should establish a fnvm to produco some of the foodstuffs now bought, tho Minister • added that ho wanted to see the existing friction 'removed. .(The board was asking for o. very large sum of money, somo £81,000, find he thought thoro should bo reasonable .'conciliation on the part of the board.
An Advisory Committee. Tn conclusion Mr. Russell said he had a suggestion to make. The board liad legal power to add outside members to its committees and to allow these members to share in tho work of administration. . He thought that without loss of dignity the board could enlarge the Knance Committee to includo representatives of tlho contributing authorities, and create an Advisoiy Committee composed of such representatives.- He made that suggestion to tho board with tho object of preventing friction in the future. In conclusion, Mr. Russell asked the conference to decide whether or not tho appointment of ■» commissioner was desirable. Air. Luke's motion was carriod. _ Mr. M'Ewan moved that in tho opinion of the conference the Government should be recommended to bring down legislation next session with the obieel: of placing the subsidies on a more equitable basis. This motion was seconded and carried without dobnto. Mr. Townsend moved that tho Oovcrumont should bo urged to take over the' hospitals in the chief centres, Mr. Russell said there was no shadow of chance of auy Government agreeing to placo the wholo charge for hospitals on tho Consolidated Fund. Government might agree to take over tho hospitals if «, tax equivalent to the present levy was continued in the districts concerned. That would be State control, not nationalisation. Mr. Townsend said he would not press the motion. He felt, that the contributing authorities ought to know what money they had to find for hospital maintenance each year. Anything extra should come from another "source Mr. Russell said that as a result,of the' confe.renco ho was disposed to issue a form showing exactly what information should bo supplied by hospital boards to Ihe contributing authorities. A Government subsidy would be available on money spent on providing farms in conjunction with hospitals. Afr. Baldwin Raid the board hud moved to establish a dairy farm, but the local authorities had objected that the Government had not been favourable, 'lie still believed llial the hoard ought to own a dairy farm. Tho conference closed with a vote of thanks to the Minister. Mr. Russell, briefly returning thanks, siiid he felt sure that the members of the board had done a great deal of good work. The conferenco would help them to make improvements.
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Dominion, Volume 11, Issue 238, 26 June 1918, Page 7
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4,558HOSPITAL LEVIES Dominion, Volume 11, Issue 238, 26 June 1918, Page 7
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