HOSPITAL MAINTENANCE AND MANAGEMENT (MEMORANDUM ON, BY INSPECTOR OF HOSPITALS).

Appendix to the Journals of the House of Representatives, 1885 Session I, H-18b

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1885. NEW ZEALAND.

HOSPITAL MAINTENANCE AND MANAGEMENT (MEMORANDUM ON, BY INSPECTOR OF HOSPITALS).

Laid on the Table by the Hon. Mr, Stout, with the Leave of the House,

The Inspectob of Hospitals to the Hon. the Colonial Secbetaey. The number of the colonial hospitals is thirty-seven. None have been either added to the list or taken from it for several years, with the solitary exception of the Sanatorium at Eotorua. Some small additions have been made to the accommodation for patients at Gisborne, Hokitika, Invercargill, Kumara, Napier, New Plymouth, Queenstown, Tham.es, Wanganui, and Westport. In several instances the chief reason for providing a local hospital has been the want of a resident medical practitioner, for whom no sufficient inducement existed in the absence of a Government subsidy. It is scarcely necessary to point out that this is a very extravagant way of subsidizing a surgeon, to whom the salary paid is often quite disproportionate to the hospital work which he is called upon to perform. Setting aside this reason, which should scarcely be a matter for Government to consider, I believe that the following hospitals might, without inflicting any great hardship, be at once abolished —namely, Arrowtown, GreytoAvn, Patea, Picton, Waimate, Akaroa. Arrowtown is only about ten miles distant, by a good road, from the Frankton Hospital, which, with the alterations and additions now in progress, will amply suffice for the whole district. Greytown is within easy distance by rail of Masterton Hospital, which possesses ample accommodation. Patea is accessible by rail from both Wanganui and New Plymouth. A new hospital is required at the former town, and room can be provided for any cases from Patea. Picton Hospital patients can be all received at the new T hospital to be erected at Blenheim. Waimate Hospital is totally unnecessary. Abundance of vacant accommodation, of very superior character, exists at Timaru Hospital, within easy distance by rail. Akaroa Hospital is a mere offshoot of the institution at Christchurch, and is not wanted. - The expenditure upon these six hospitals considerably exceeds £3,000 annually, of which sum considerably more than one-half is contributed by the General Government. In the next category I place the following hospitals —namely, Charleston, Coromandel, Clyde, Kumara, Eiverton, Eoss and Waipawa. Some of these are very little used, while others are within reach of more important towns where complete establishments already exist. Upon careful consideration of their circumstances, it may be found practicable either to close some of these hospitals or to reduce the cost of their maintenance. Charleston has, upon my last two visits, been quite empty. A salary of £150 a year is paid to the visiting surgeon. Westport Hospital is about eighteen miles distant by road. Coromandel is within easy distance by water of Grahamstown and Auckland. There are usually two or three patients under treatment there ; the salary of the medical officer being £200. Clyde is within an easy journey, by road, of Cromwell Hospital. Kumara is about sixteen miles by tramway from Greymouth and twenty-two from Hokitika. At both of these towns complete hospitals exist. Eiverton is within reach of Invercargill by railway, and, though the journey is now a very slow one, this matter may be improved. Eoss is about twenty-two miles south of Hokitika, on a good road. There are usually only three or four patients here, for attendance upon whom the medical officer receives a salary of £200. Waipawa.—The patients now treated at Waipukurau Hospital might be sent by rail to Napier. It will be necessary to provide accommodation for a few additional beds at Cromwell, Hokitika, Invercargill, and Napier, if the whole of the above-named establishments be closed ; but if proper " refuges " be provided the increased accommodation need be neither extensive nor costly. Large districts of the colony are at present destitute of any hospital accommodation within reasonable reach. lam not in a position to judge of their requirements from my own knowledge ; but as population increases new institutions will be needed. In arranging for the future maintenance of the colonial hospitals several important matters demand attention : Firstly, the present want of any system of subsidizing is fast doing away with any local efforts to raise funds. In many places all charitable donations have long ceased entirely. Secondly, the provision of free hospital treatment by the Central Government is pauperizing the population to an alarming extent, and taking away inducements for thrift. Thirdly, extravagance

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of management prevails in the hospitals, and will continue to do so as long as the locality benefits by the expenditure of money provided almost wholly by the General Government. Fourthly, a large proportion of the patients treated in the hospitals are not proper objects of charity. The legislation regarding the collection of maintenance-money from them is defective, and the machinery inefficient. Payment on recovery of health and income should be insisted on. A large annual sum is lost to the colony in this way. Fifthly, the hospitals are encumbered with aged persons, incurable cases, and worthless fellows, who would find a home in a workhouse in England. The cost of maintaining such people in a hospital far exceeds what would be necessary in a properlyappointed refuge. It appears to me that the Government cannot allow matters to rest as they-are at present, but must take one of two courses. The first is to take over the whole of the hospitals, and place them upon the same footing as the lunatic asylums. Under this plan great difficulty would at times arise in excluding unfit patients ; and local authorities would see no sufficient inducement to assist in reducing expenditure. The second course is to hand over the hospital to a certain assigned district, the whole property in which might be locally assessed for its maintenance, either in whole or in part. In this way only can extravagant expenditure be checked. The Central Government might contribute a fixed sum per day towards the maintenance of each patient in hospital; and, in order to stimulate and encourage private and municipal subscriptions, a further sum per day for each inmate, not exceeding one-fourth of such private and municipal subscriptions. All patients retained in hospitals beyond, say, six weeks to Be paid for by the Government, after the expiration of the said period of six weeks, at the lower rate allowed in refuges ; and all cases deemed by the inspector or inspectors to be unfit persons for hospital treatment to be placed in the same (refuge) category. All hospitals receiving Government aid should be required to provide and maintain such accommodation for patients as, with the advice of the inspector, may be deemed necesssary; no new building to be erected, nor any addition made to an existing hospital, until detailed plans of the same have been submitted and approved. All appointments of officers to hospitals to be of permar.ont duration during good behaviour, such appointments to be submitted to Government for confirmation. The inspector should have power to deal with all defects, irregularities, and troubles as they arise, whether structural, administrative, or disciplinary. The above suggestions are borrowed from the system now successfully carried out in the Province of Ontario, whose " Act to regulate Public Aid to Charitable Institutions " is attached hereto. It is easy to foresee certain difficulties in the way of introducing the necessary reform, not the least of which will be the mapping out of the colony into its several hospital districts. It will also be necessary to provide against the gravitating of patients into districts where a popular doctor may be in charge of the hospital, as is now often the case. The migration of invalids to certain parts of the colony which have the reputation of possessing a salubrious climate must also be dealt with, as it would be obviously unfair to saddle one district with the maintenance of the sick from others less salubrious. The law of settlement gives constant trouble in England, and, with our frequent new arrivals and shifting mining population, will demand careful consideration in this colony. In the provision of refuges, wards should be set apart for the reception of " aged imbeciles " and " harmless insane persons." Large numbers of these two classes are now being removed, in England, from the asylums to the workhouses, where they can equally well and more economically be maintained. G. W. Geabham, 26th March, 1885. Inspector of Hospitals. [Approximate cost of Paper.— Preparation : Nil. Printing (1,225) copies: £1 2s. 6d.]

By Authority: Geobge Didsbuey, Government Printer, Wellington.—lBBs.

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