HIGHER HOSPITAL LEVY.

Shannon News, 18 May 1928, Page 4

HIGHER HOSPITAL LEVY.

COUNTY COUNCIL CONSIDERS ITS BURDEN ANOMALOUS.

POPULATION BASIS URGED IN ADDITION TO CAPITAL VALUE.

A further increase in the levy on the Horowhenua County for the support of thd Palmerston Nox-th hospital was the subject of a debate at the County Council meeting on Saturday, when it was decided to prepare a remit for the Counties' Conference advocating an alteration of the law so that Hospital Board levies shall be made in such a manner that the populations of the contributing areas shall be taken into consideration as well as their capital value.

The Palmerston North Hospital Board forwarded a copy of its estimates for 1928-29. The proposed maintenance levy was £21,503 in all, as compared with £17,600 last year. The levy on the Horowhenua County was £4207 15s 6d, consisting of £631 18s 4d capital levy and £3575 17s 2d for maintenance. Last year the levy on the county was £3446 13s 2d. The chairman (Mr G. A. Monk) said that three members of the Council were members of the Hospital Board, and whether the work of the representatives of this district had been good or not was for the Council to say.

Mr Monk represents the Levin, Otaki, and Shannon Boroughs on the Board, and Crs. Catley and Ryder and Mr S. A. Broadbelt represent the. County. The chairman went on to say that the Board had found it necessary to increase the levies on local bodies,,and some explanation was due to the Council. The increase in the levy on this County was £761 2s 4d, which was fairly considerable. Very strong exception had been taken to the increases in the levies, particularly by the Palmerston North Borough Council, and a complete reply to that criticism had been sent out in circular form. CAUSES OF THE INCREASE.

After moving that the estimates and other information be received, the chairman said he felt that a duty devolved upon him and the other representatives from this district to say something as to the cause of the increase of the levy. One of the prime reasons was the increased number of patients being treated in the hospital. At the end of March, 1927, the daily number of patients was about 140, but during the past year the average daily number increased to over 180. Another reason for the increased levy was the enormous amount of money that had had to be distributed in charitable aid as compared with other years, this being due to hard times and unemployment, people in this country not being allowed to starve. There were many cases of great hardship, and it was absolutely necessary that relief should be granted. The Board had also, this year, built in Palmerston a maternity hospital. This might not be of great benefit to the outlying districts, but it would be of benefit to Palmerston North aritd the immediate district. That institution had been built without cost to,this district in capital expenditure. It had been built by public contributions subsidised by the Government, and it would be opened on May 28th. It was hoped 'that,' while it would immediately serve Palmerston and the surrounding districts, it would be possible to train nurses there who would be able to go out into the more outlying portions of the district. The maintenance was expected to involve a considerable amount annually, and this accounted for part of the increased levy. The Board had also agreed with the Health Department to take over the Otaki hospital after certain alterations have been made. That would cost the Board some £ISOO a year. There were reasons, therefore, and very valid ones, why there was an increase in the levy.

LARGE QUOTA OP

PATIENTS,

The levies were made on the capital value, the chairman continued; but practically half the number of patients were from the town of Palmerston—namely, 46 per cent. It was the Palmerston Borough which had complained so bitterly of the cost. He would suggest that this Council frame a remit for the Counties Conference- in the direction of altering the system of levies, so that, instead of being based wholly on the capital value, they be based partly on the capital value and partly on population. In Palmerston the levy under that proposal would certainly be increased; but when it was considered that that town was receiving over 40 per cent, of the benefit, it was quite apparent that that was the portion of the district that should bear the burden. At present the proportion of maintenance collected from Palmerston was less than from the other districts. He was sorry to have to raise the question of Palmerston, but that Borough had been rather hard on the members of the Board. MINIMUM SUBSIDY RECEIVED.

The chairman went on to say that the Hospital Boards had a system whereby they could draw on their subsidy throughout the year, and very often the Department found that the subsidy was overdrawn. The Department then levied back on to the Boards the amjounts according to capital value, and the Boards had to repay them. The result with this Board was that it had been getting the minimum subsidy of 14s 3d, whereas the maximum was 265. Last year the Board had to make a refund of £BOO, with the result that, although the subsidy was fixed on a 15s basis, it was reduced below the rate allowed by the statute. It would not quite have that effect this year, but very nearly so. This matter would have to be taken up with the Minister, but there was no legislation yet dealing with it. Aa far as the Board was concerned, the chairman concluded, it was an efficient Board and was endeavouring to

give efficient service at a minimum of cost. He paid a compliment to the managing secretary (Mr A. J. Phillipps) who was keenly alive to the interests of the Board and who endeavoured to keep down the cost to the ratepayers. ECONOMICAL ADMINISTRATION.

Cr. Catley: The figures show that it is one of the most economically administered institutions of its kind in New Zealand. *

Cr. Barber: It seems it is pretty bulky as a Board. The Chairman: The cost of the members does not amount to much. Cr. Barber: You have 17 to 20 members, if not more. The Chairman: Well, you have a democratic representation, and it is a very brave man nowadays who will suggest that you exit that down and make it autoeratic. Cr. Ryder: I agree with the chair-! man that we have a most efficient secretary. I really think to-day that that institution is run on as economical lines as possible. t Cr. Jensen: How much money was spent in new buildings, and what is the number of beds available? Cr. Catley: They are right up to the maximum. Cr. Jensen: Then they will be faced again, with more building. The Chairman: We have no method of controlling the number of patients who come in. Our duty is to cater for those sick people who are brought there. Cr. Jensen remarked that the ambulance would take a large number of patients to Palmerston. The chairman stated that provision had been made for the building programme, and tenders would be called next month. The nurses' home had been completed, and the contract for the new wards in the main building was to be let next month. There would then be nrovided about 190 beds. There were 180 patients, but that fact did not indicate that 180 permanent beds were provided—emergency beds and wards were established when necessary. What Cr. Jensen contended was that the building programme was not fulsome enough.. That fact was fully realised by the Board, but he did not think that the present scheme would alter the cost of any future building that might be required. If still further accommodation had to be provided, it would mean a separate ward. An average daily increase of 40 patients in one year was pretty considerable, and that had not taken place when the present building programme was framed.

Cr. Barber: Is the hospital understaffed with nurses? The Chairman: No. We are one of the few Boards in New Zealand who follow the principle of giving a nurse one day off in seven. POSITION OF OTAKI.

Cr. Kilsby asked if it would nat be preferable to increase the number of beds in the Otaki hospital. Quite a number of patients were taken to Palmerston Avho could quite well be treated in Otaki.

The Chairman: I don't feel to-day that I should enter into a controversy as to the accommodation that should be provided at Otaki. I have fought for some years for the accommodation .required at Otaki. We have agreed fo accept certain conditions which include the establishment of a maternity ward at Otaki. I am not prepared to enter into a discussion as to what the future requirements of Otaki may be. The requirements of the Board and the Department were settled, but I understand that the matter has been taken further. WHERE THE PATIENTS COME FROM. Cr. Catley quoted the following figures from the reply of the Board to the Palmerston Council, showing the places from which the patients came during the past year:—Kiwitea County, 48; Pohangina County, 18; Oroua County (possibly includes some Pohangina),' 153; Kairanga County, 202; Manawatu County (possibly includes ■several from Wanganui district), 194; Horowhenua County, 130; Feilding Borough, 232; Palmerston North Borough, 1234; Foxton Borough, 125; Shannon Borough (possible includes some Horowhenua County), 94; Levin Borough, 102; Otaki Borough, 43; Rongotea Town. District, 37; patients from outside Board's district, 36. Total 2654. An examination of this revealed the fact that 1234 out of 2654,, or 46 per ,cent. of the hospital patients came from the Palmerston North Borough, and it was safe to assume that of the increased number estimated for during the coming year, more especially as the maternity home would be used almost exclusively by, Palmerston North residents, 50 per cent, would come from the Palmerston North Borough. Itwas also shown in the statment that more bad debts were laid to the account of Palmerston patients than those from the outlying districts. Cr. Catley added that the secretary of the Hospital had made a very valuable suggestion in his annual report, and that was that wherever there was a difficulty in collecting the fees he should collaborate with the Board member in that part of the district to ascertain particulars of the debtor's position.

GOVERNMENT CONTROL SUGGESTED.

Cr. McLeavey objected, to the large amount of the County's quota of the Board's expenditure, which meant that it was costing the County about £3OO for each patient sent from this district.* The method of allocating the charges did not seem fair; and the Council should go into the question thoroughly and see if it could not have ■the system altered* He considered that the Consolidated Fund should pay the expense; it should be a Government matter, and not one for the County at all. ( Cr. Kilsby expressed the opinion that some fresh legislation should be brought down calling upon Palmerston to pay a larger share towards the cost of running the hospital. The levy had been increased each year, and it was impos-

sible to say where the increase was going to eiid. '."We shall have paid sufficient money from our County to run a hospital of our own," he added. PRIVATE HOSPITALS SERVING COUNTRY DISTRICTS, v Cr. Jensen said that ho was not surprised by the figures quoted by Cr. Catley. The private hospitals took the majority of sick people from the outlying districts. That was because those people were able to pay; another reason was the expense of getting them to Palmerston. As far as the Board was concerned, it was doing what it was able to do; but ' whether the amount provided was sufficient to meet the situation so that the Board could function on just Hues was open to great differences of opinion. The doctors would take people into their own hospitals in preference, if they were able to pay. The Chairman: If you said the public hospitals were starved by the B.M.A. Cr. Jensen: That is what I say. The Chairman: I have not said so. Cr. McLeavey has suggested that a greater proportion of the cost should be borne by the Consolidated Fund. Owing to the high capital value of our Board's district, we were getting the lowest subsidy last year, I think, of any Board in the Dominion; we were a rich district, with a high capital value. The counties have long felt that there has been an undue burden on them, and they have advocated, for some time, a system of levying partly on capital value and. partly on population, instead of always on capital value. I think the Council would be quite justified in submitting a remit on those lines to the Counties' Conference this year. It will be a hardy animal, but still we have to recognise that the constant drop of water wears away the hardest stone, and some day we may achieve, partly if not wholly, our desires in that respect. The contention that more people from the country districts go into private hospitals because they are more easily available is quite true. Although we have a rising levy, there is a justification for that so far as the Board is concerned, provided that the law remains as it. is to-day. We are there to administer the law as we find it. If you are not satisfied with the law, you have to .take means to try to have it altered. Cr. Kilsby seconded the motion that the statement be received, and it was carried. He urged that a remit for the Counties Conference be prepared, and the Chairman promised to undertake this. The N.Z. Counties' Association gave notice that the conference would commence on July 17th, in Wellington; and the Council appointed the chairman as its delegate.