13

fl.—3la,

The district nursing carried out by St. John Ambulance Association and similar associations should be co-ordinated with the work of the local Hospital Boards so as to prevent overlapping. From evidence heard your Commission is of opinion that a working arrangement should exist between the Knox Incurables Home Trust Board and the Auckland Hospital Board. The work of the Knox Home is most important, but the institution apparently is becoming financially embarrassed. The Hospital Board is prepared to assist, but quite properly wants representation on the controlling Board. Your Commission favours this, and, seeing that the State contributes largely to the Trust Board, considers the Government should urge the affiliation. The importance of the national work carried out so successfully by the Plunket Society justifies the financial assistance given by the Government. This great organization is engaged in the most important preventive work. By practical demonstrations and propaganda it has spread its beneficial influence throughout and into the most remote parts of the Dominion. The country is the gainer. Healthy children mean healthy adults, who will be less likely to become a burden on the hospitals and other such public institutions. Your Commission considers that every encouragement should be given for the extension of the work, and that it will be to the advantage both of the Government and the society if two Government nominees are appointed to the society's council. One should be a medical practitioner, and such representative should be the founder of the society, Dr. Truby King ; and the other should be an officer of the Health Department with accountancy experience. The Commission is also very much impressed with the philanthropic work done by the Salvation Army with very little help from the State, and recommends that it continue to receive, through its headquarters, financial assistance from the Government. It is clear from the evidence given that very valuable work is being done by most of the charitable societies by means of voluntary service as well as of voluntary contributions. In the case of female rescue work and orphanages in particular the effect of the personal influence brought to bear is very great, and results are achieved which cannot always be obtained by more official organizations. Your Commission feels strongly that, while care should be taken to avoid overlapping, nothing should be done to discourage the spirit of voluntary service in the community. HOSPITAL FEES. Para. 6. (a). The fees that should be charged for maintenance and treatment in public hospitals. Maintenance Charges. As shown by the returns, the average cost per occupied hospital bed (excluding interest on capital) amounted to about £3 per week for the year 1919-20. The weekly maintenance fee charged for patients in hospitals during that period varied from £l Is. to £3 3s. In every instance the charge was less than the cost, but as the fixed charge was the maximum maintenance fee collectable, the Boards could not demand more than that sum, even if a patient were well able to pay the full cost of his maintenance. Your Commission considers that section 51 of the Destitute Persons Act, 1910, should be amended with a view to empowering Hospital Boards to demand the full cost of maintenance, regardless of any fixed charge, where circumstances warrant such increased demand. Recently there has been a general tendency among Boards to raise hospital fees. Your Commission recommends a uniform fee for maintenance in all hospitals of 9s. per day, and half-rates for children, leaving to the Boards the right to reduce such charge in necessitous cases, and to contract with friendly societies for their members on a basis of half-fees guaranteed. The low fees now charged for members of friendly societies by some Boards —notably Auckland (2s. 3d. per day) and North Canterbury (Is. 7d. per day)—seem quite inadequate, and bad business for the Boards.