§ THE EARL OF MALMESBURY had given Notice to ask His Majesty's Government—
- 1. What progress the Voluntary Hospitals Commission has made in appointing local voluntary hospital committees in accordance with the Report of Lord Cave's Committee.
- 2. What information the Voluntary Hospitals Commission has of the general financial position of the hospitals and how far they have proceeded in the distribution of the Government grant of £500,000.
§ The noble Earl said: My Lords, the House will shortly rise for the Whitsuntide recess, and I knew there are very large numbers of people, in different parts of the country, who are much interested in this subject and are anxiously awaiting a statement from His Majesty's Government. I ask these Questions in no spirit of captious criticism, because I can say nothing but good of the work which has been done by the Voluntary Hospitals Commission as regards the establishment of committees and other work, and I desire to thank the noble Earl, Lord Onslow, for the enormous amount of devoted personal service which he has put into this business.791
§ The first Question I wish to put is: What is the exact position of the voluntary hospital committees to-day? How many committees remain still to be formed, and has the scheme been generally well responded to throughout the country? The next question is: Can the noble Earl tell me what proportion of the fund has been distributed already, and how much, if any, still remains for further distribution? I know the difficulties that my noble friend has probably had to meet. Hospitals have been very dilatory in sending in their accounts, and I am fully prepared to hear that my noble friend has had many difficulties of that sort to meet. Can my noble friend tell me anything in regard to the form in which these grants are made? I hope that any risk of the well-managed hospitals getting less money than the less well-managed hospitals may be avoided. Some suggestion was put forward that we might possibly give a bonus on good management, but that is a difficult matter.
§ With regard to further expansion, I take it that, with the present shortage of money, there is no possibility of any funds being available for further expenditure. The sources of hospitals are dried up owing to taxation and the effects of the war, and the demands put on these hospitals have daily increased. The cost of running hospitals is very much higher, the number of persons who expect treatment in them has enormously increased, and you get a different class of patient going into hospitals. Another point, which is a somewhat delicate one, is the question of poor law infirmaries. Naturally, the Poor Law Guardians and the ratepayers are somewhat jealous of their infirmaries being used for ordinary hospital purposes. But I hope that some means may be found whereby there will be a greater exchange of duties between infirmaries and ordinary hospitals, provided that the beds in the infirmaries do not fail to supply the need for which those institutions were established.
§ The next point I desire to raise is that of voluntary hospital representation on the Commission. Many of your Lordships have taken an interest in hospital work, and no doubt you know that it is impossible to lay down a hard-and-fast line for all hospitals. I hope some means will be found by which some representative of these voluntary hospital committees will be given a place upon the central Commission sitting in London. I think it would be 792 to the mutual advantage of both, and very much to the advantage of the voluntary committees themselves. I believe that the King's Fund and several other bodies are already represented on the Commission. I beg to put the Questions standing in my name.
THE PARLIAMENTARY SECRETARY OF THE MINISTRY OF HEALTH (THE EARL OF ONSLOW)
My Lords, the noble Earl, who is chairman of the Hospital Saturday Fund, is anxious to receive information on this subject. In answer to his first Question on the Paper, it is proposed to constitute, in all, 62 committees throughout England, Scotland, and Wales. Of this number, 52 are already formed, and are actually functioning; six will very soon be ready. The only reason why they have not actually commenced work is that all the nominations have not been completed. In two cases, one in England, the other in Scotland, no committees are to be formed because the local conditions are such that it is not necessary; there is only one hospital in one county, and it would be obviously unnecessary to appoint a committee. In two others no decision has been reached.
Some of these committees have been in existence for a considerable time, but the majority have only begun to work in the last few months. We asked them all to send in a report as to the actual situation in their area, and many of them have sent in valuable reports, though we have not, of course, received sufficient information about all the small areas to be able to make a comprehensive survey of an authoritative nature of the situation throughout the country. We have had very good reports from Devon, Cornwall, Warwickshire, Bristol, Derbyshire, Wiltshire, Sheffield, and others I might mention.
With reference to a point to which the noble Earl referred at the end of his speech—namely, the question of the representation of local committees on the Voluntary Hospitals Commission—as your Lordships are aware, that Commission was formed on the recommendation of Lord Cave's Committee, with the addition of a representative for Wales. Of the representatives on that Commission, five are appointed by the Ministry of Health, one by the Secretary for Scotland, and seven by various bodies connected with the hospitals—the Royal Colleges of Surgeons and Physicians, the Order of St. John and the British Red 793 Cross Society, the British Hospitals Association, the British Medical Association (which has two representatives, one for England and one for Scotland), and King Edward's Fund.
King Edward's Fund has accepted, in accordance with the recommendation of Lord Cave's Committee, the position of voluntary hospitals committee for London; so that in that respect the metropolitan area is directly represented on the Commission. The other committees, of course, were not formed when the Commission was appointed, so that there could be no question about their being represented thereon, but now that they are functioning the question is one of very great importance and has not been lost sight of. I may say that a conference of all members of local committees will meet in London on July 18 and 19, at which a full discussion of this question will be possible. The views of the members of local committees as to whether the Commission would be strengthened by adding representatives drawn from London, and whether they think it desirable in their own interests to be so represented, will be of very great value and importance. How that representation should be made, and so forth, is a matter of interest to all concerned. I wish that the noble Viscount, Lord Cave, had been present because it would be very interesting to hear his views on this point, as he was the originator of the idea and it was on his advice that the Commission was formed. Personally, I think an important thing is to avoid making the Commission so large as to be an unwieldy body, but I do not think that would be a necessary corollary to the proposal.
I now turn to the second part of the Question which deals with finance. The original Government grant was of £500,000. Up to the present we have spent altogether £142,738, which is made up as follows: In London, £103,450, and in the provinces, £339,288. Your Lordships will comment, perhaps, on the fact that London has received so considerable a share of this sum of £142,738, but the difference is due to the fact that London was able to get to work very much more quickly. As I have already observed, King Edward's Fund set to work immediately as the voluntary hospitals committee for London, and therefore the reports and so forth were available much more speedily for London than they were for the provinces. The London 794 grants so far have been mainly, in fact, almost entirely, emergency grants; that is to say, grants to hospitals who have exhausted their realisable assets. The grants, therefore, were mostly given before the annual accounts were made up. I am glad to say that these grants have enabled beds in London which were closed to be reopened and have prevented the threatened closure of others.
In reference to the other Question which the noble Earl put to me as to the principle on which the grants have been made, I may say that the Commission have decided as a general principle not to make grants in excess of half the deficit on the ordinary maintenance expenditure for the year ending December 31, 1921, and those grants are to be made £for£ against new money received or in sight. This question of money received or in sight is rather a difficult one to define, and we have had a good many inquiries about it from the hospitals and the voluntary hospital committees. We have explained it to the best of our ability, and we are just issuing a new circular dealing with the whole matter at length, which I trust will put everybody in a position to understand exactly what is meant by the Treasury conditions.
As to the position of the hospital finances I would like to say a word. The Government grant of £500,000 was based on the estimate of Lord Cave's Report that the total deficit on maintenance account for 1921 would be approximately the same as that in 1920—namely, £1,000,000 for the whole country. But it is very gratifying to note that the reports so far almost all show that in all probability the 1921 deficit will be less, and I think and hope that it will be considerably less, than the 1920 deficit. The 1920 deficit in London amounted to £463,000, and the estimate—it is only an estimate yet, but it is a fairly accurate one—is that the deficit for 1921 will be about £140,000 less. The same sort of figures reach us from other localities, and, therefore, I am in great hopes that the deficit for 1921 will show a considerable shrinkage on that for 1920. That being so, we may hope that our finances will allow us to give some assistance in respect of accumulated deficits. I am not able to make any promise on that point, and I cannot say anything really definite about it until we have a complete estimate of the amount of the deficits for 1921 throughout the whole country.
795 The noble Earl referred to the fact—and, perhaps, your Lordships will have seen that it is true from the small amount of money that we have already distributed—that the hospitals have been somewhat dilatory in sending in their claims. That is the case. We have written to the hospitals, and have sent a communication to the Press to the same effect, asking them to send in their claims as soon as possible and without any unnecessary delay. I understand, of course, that hospitals have found some difficulty in making up their claims because they do not make up their accounts until the beginning of the year, when the auditors' officers are very busy and it is very difficult to get a proper audit. We are now almost at the end of May, and I hope we shall be able to get our claims in soon so as to be able to proceed with the distribution.
There is another point I should like to mention because it is one which I think hospitals would do well to consider. An arrangement was made with Approved Societies last year for payments to hospitals in respect of their members. We have had representations from the societies that the claims are not coming in from the hospitals. I hope, and the Commission hopes, that all hospitals will ask any patients who come to them whether they belong to a society, and, if so, whether it is one of those societies as to which the hospital has to make a claim; also that the hospitals with as little delay as possible will make the claims they are entitled to make, and which the societies are desirous of meeting, in respect to the treatment of these patients. I hope I have been able to indicate to your Lordships that the position of the hospitals is improving. It must, however, be remembered that the deficits are still very formidable, that no effort must be relaxed and that everything possible should be done to put the hospitals again on to their pre-war footing. Cooperation, I am sure, is the only way in which that may be successfully done—cooperation to reduce expenditure, to increase income, and to prevent overlapping and waste.
I should like to mention one other point in regard to that matter. Certain hospitals are proposing schemes for extension. I feel that these schemes of extension should he very carefully examined. I am sure it is not a wise procedure to build a new wing to your house before you are able to pay 796 the weekly bills. Hospitals should not only see that they are paying their way, and able to carry on, as they are at present, their ordinary work, but they should also see that their income is sufficient to pay for any increased expenses of maintenance which the extension will necessitate. That is a matter which should be most carefully examined by all hospital committees. I do not want to say that an extension should not be undertaken. In circumstances of a peculiar nature, even when the maintenance account is somewhat deficient, it may be desirable to have an extension, because sometimes capital expenditure is true economy. But it is a matter which requires careful and serious consideration on the part of those who propose to undertake such developments.
The noble Lord referred to the possibility of utilising poor law infirmaries. The noble Viscount, Lord Burnham, who is not here to-night, raised this point last year. These infirmaries are said to have occasionally vacant beds which could be utilised; I have no doubt that is often the case. Actual co-operation of that kind has been undertaken in certain places; for instance, in Paddington and Wolverhampton. I went to Paddington infirmary. It is an admirable place, and works with the local hospital in a magnificent manner. But one must remember that the poor law infirmaries are the property of the ratepayers, and that you cannot do anything to touch them unless the guardians and the ratepayers come forward and say that they are ready and willing to oc-operate with the voluntary hospitals. Now that local committees have been formed there is an authority which can deal with the voluntary hospital area extension. A local committee can form an idea of what is required in the way of beds, and, if the poor law authorities in the district are willing to meet them, they can come together and perhaps form a scheme which will utilise the beds that are vacant in the infirmaries, if such there be. That will relieve the voluntary hospitals, and may, perhaps, avoid the necessity of considerable extensions in the hospitals. The essential point to remember, however, is that these infirmaries are the property of the poor law authorities, and that only with their consent and cooperation can anything whatever be done. There are many members of boards of guardians who are also members of voluntary 797 hospital committees, so that cooperation between the two should not prove a difficult task.
I should like to say one further word upon the question of finance. So far as our information goes income on the whole is well maintained, although in a few cases there has been a falling off, especially in areas where there have been strikes. Speaking generally, the income has kept up in a rather remarkable way, in spite of unemployment and high taxation. Again, expenditure is falling. Food, which is a very large item in hospital expenditure, is coming down considerably, but drugs and dressings are remaining at a rather high figure, and have not fallen in the manner which had been hoped and anticipated.
I would make one comment on the success of the scheme of mass contributions. I do not know whether any of your Lordships are familiar with the Sheffield area, but in that area they have done very remarkable work under this scheme of mass contribution. It is very important for local committees to keep that matter in mind, and to organise schemes wherever they possibly can. Until the Oxford scheme was developed the mass contributions were mainly confined to Northern England, and the success of the scheme at Oxford is worthy of note. The chairman of the hospital committee told me the other day that they raised £16,000 last year by these contributions. This is mainly an agricultural County, and the success of that scheme in Oxford shows that similar efforts might be undertaken elsewhere with success. I believe the noble Lords own County, Hampshire, has made a great success already of the scheme. In Manchester they have made an arrangement with the Hospital Saturday Fund for a combined collection and the organisation of mass contributions. These schemes are of the utmost value, and are to be recommended to the consideration of committees. I may add a word of congratulation to London. I think the London collection yesterday must have been very successful. I hope it will realise all the new money that is necessary to obtain funds from the Commission.
THE EARL OF PORTSMOUTH
My Lords, I should like to take this opportunity of joining in the tribute which the noble Earl, Lord Malmesbury, paid to the noble Earl at the head of the Commission. I am a member of the Devon local hospital 798 committee. We sent in our claims, and within a month received promise of the assistance that we were going to get. I think that is extremely satisfactory, and shows the enormous amount of personal attention that the noble Earl has paid to the matter. I understand that not half of the £500,000 has yet been distributed. I think I am right in saying that, apart from London, something like £100,000 only has been promised.
THE EARL OF ONSLOW
I have not the figures by me, but I think £103,000 has been distributed in London, and about £39,000 in the provinces. I trust that there will be considerably more funds for the provinces when w get in the claims. If all the counties were as assiduous as the noble Earl's County of Devon we should have distributed a great deal more to the provinces.
THE EARL OF PORTSMOUTH
I am grateful to the noble Earl for that statement, and I should like to know whether the claims that the various local committees have sent in are the final claims that they can make?
THE EARL OF ONSLOW
If the noble Earl has any further claims to make the Commission will be only too glad to consider them.
THE EARL OF MALMESBURY
My Lords, I thank the noble Earl for the statement he has made, and congratulate him upon the success of the scheme so far.