3

H.—22

The following table shows the expenditure of the past two years :— 1908-9. 1909-10. £ £ Provisions ... ... ... ... ... 42,485 40,552 Surgery and dispensary ... ... ... 16,959 16,809 Domestic and establishment ... ... ... 40,965 44,304 Salaries and wages ... ... ... .... 67,160 69,837 Total maintenance ... ... ... 167,569 171,502 Administration ... ... ... ... 8,731 9,529 Capital expenditure ... ... ... ... 55,837 52,341 Miscellaneous expenditure ... ... ... 4,666 4,268 Total expenditure ...' ... ... £236,803 £237,640 A larger decrease in expenditure under some of these items was looked for, particularly in— (a.) Provisions. —Though the returns show an increase in the average number of patients under treatment, a larger saving than £1,933 was looked for under this item. That this hope was justifiable may be gathered from a perusal of Tables 111 and lIIa, where the expenditure of hospitals that may reasonably be classified together can be compared. Take, for example, our four chief hospitals. It will be seen that the total cost of some foodstuffs in the Dunedin and Christchurch Hospitals, with respectively an average of 151 and 111 daily occupied beds, was greater than that of the Auckland and Wellington Hospitals, with respectively 242 and 223 occupied beds. For instance, it will be seen by Table lIIa that the actual cost of meat, fish and poultry, butter, eggs, and bread was greater in the Dunedin than in the Wellington Hospital. It is no doubt true that the fare in the smaller hospitals is more varied, but this cannot explain the discrepancy; nor could it be explained by the difference in the local prices of foodstuffs (see Table VI). It is certainly curious that the cost of butter, eggs, and bread is greater in the Christchurch than in the Wellington Hospital, with more than double the beds. The tables throughout show a similar disproportion, and they will well repay a careful perusal by those interested in hospital economics. In last year's report it was pointed out that hospital authorities should take good care to get what they pay for, and that there is no waste. Some Boards have done good work in this respect, but others are still very slack, and some officials worse than slack; but they are gradually being got rid of. (6.) Surgery and Dispensary. —The drug and dressing account for the Dominion is still stupendous. Though Hospital Boards have been circularized as to the reasonable cost of articles in daily use, and asked to submit tenders, there has not been the response that was hoped for. For fear of offending the local chemist, some authorities continue to pay highly —at times double the prices paid by others. We must not be content with a small decrease in this item, and I fear that until the Department can initiate a bureau for the purchase and distribution of drugs and-dressings the present high prices will rule. (c.) Domestic and Establishment. —One of the chief items in " Domestic and establishment " is "Bedding, furniture, crockery, &c," which in many of the hospitals needed considerable replenishing. We can look for little reduction here, as better equipment in beds, bedding, and hospital furniture generally is much needed. Some of the beds and lockers in the wards of our larger hospitals are badly designed, exceedingly shabby, and in some cases insanitary. Much saving may be effected in " Fuel and light." Imagine a hospital of twenty-five beds with a gas-bill of £22 per month ! (d.) Salai-ies and Wages. —The increase in the item " Salaries " is due to the increase in the general staff, as may be noted in Table I. Staff. 1908-9. 1909-10. Increase. Stipendiary medical ... ... 73 80 7 Nurses, trained ... ... ... 185 210 25 ~ probationer ... ... 436 452 16 Domestic, female ... 262 282 20 male ... ... ... 153 155 2 Total ... ... ... ... ... 70 This increase in staff, and consequent expenditure on salaries, is not unwarranted, as is shown by the cost in salaries per occupied bed, which is less than in 1908-9.