Report from the Select Committee of the House of Lords on Metropolitan Hospitals, &c. : together with the Proceedings of the Committee, minutes of evidence, and appendix. / Ordered, by the House of Commons, to be printed, 15 August 1890.

Date:: 1890

Credit: Report from the Select Committee of the House of Lords on Metropolitan Hospitals, &c. : together with the Proceedings of the Committee, minutes of evidence, and appendix. / Ordered, by the House of Commons, to be printed, 15 August 1890. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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$5 May 1890.] Lieut. Colonel E. Montefioue, r.a. [Continued. Chairman—continued. At these institutions it appears that in 1886 about 14,000 persons received gratuitous medical relief, while 3,800 were members of provident dispensaries, and about 2,650 paid small sums for their treatment, or obtained the necessary amount from their richer friends. Wandsworth Union includes the parishes of Wandsworth, Clapham, Battersea, Putney, Tooting, Balham and Streat- ham ; it covers 11,488 acres, and has an estimated population of 277,026. In this area there is one pay hospital ; there are three provident dis- pensaries and one general and pay dispensary combined, a maternity charity, an association for nursing the sick poor in their own homes, a Poor Law infirmary, and three Poor Law dispensaries. At these institutions in 1886, 15,731 people secured for themselves medical advice and medicine when ill by their provident payments when in health, and 1,496 paid small sums for their treatment when actually ill. The number of those v\ ho received gratuitous medical treatment through the charitable institutions of this union was 1,091, and medical relief from the rates was extended to 5,176. In the Fulham Union, with an area of 4,115 acres, and an estimated popu- lation of 152,694, there is a general hospital and two sick clubs, a Poor Law infirmary,and a Poor Law dispensary. The result is that 10,667 people received gratuitous medical relief at the hospital, 4,173 were treated by the Poor Law, and 4,500 paid in small sums for their medical attendance and medicine. If these districts be compared, it will be seen (1.) that where hospitals abound provident dispensaries languish ; (2.) that while in one district hospitals and all kinds of medical institutions are crowded together, in others there may not be even a general hospital. In a paper entitled “ Sixteen years of the Hospital Sunday Fund ” (November, 1888), Sir Sydney Waterloo, the chairman of that fund, and the treasurer of St. Bartholomew’s Hospital, writes in regard to the grouping of hospitals : “ The excessive cost of the manage- ment of small hospitals points to the evils arising, of late years, from the tendency to multiply the number of medical charities, instead of reducing them by amalgamation, coupled with a proper management for dividing them over the thickly- populated districts of London. Instead of making any further attempts to establish new hospitals, our efforts ought to be directed to the collection of funds to fill the large number of empty beds in the hospitals already established, where the expenses of management would remain at nearly the same sum, whether the beds were full or empty. That this course ought to be adopted is, J think, clearly evident from the fact that we have now 2,031 empty beds in the 71 hospitals in various parts of the metropolis. It would not cost half as much to maintain and treat patients in those beds as it would to provide the same number of beds in new hospitals.” I would point out also that in several instances hospitals and dispensaries are well placed for purposes of co- operation, e.g.y St. Bartholomew’s Hospital and the Royal General Dispensary ; St. Thomas’s Hospital and the South Lambeth Dispensary ; the London Hospital and the Eastern Dispen- sary, and so forth. 13 y way of “ settled relation” (69.) Chairman—continued. between different medical charities, the following instances might be mentioned as representing, possibly, the germs of a completer co-operation in the future: (1.) Lectures are given to past graduates in connection with the following special hospitals, viz.: National Hospital for Epilepsy and Paralysis, the Ormond-street Childx-en’s Hospital, the Royal London Ophthalmic Hospital, Moorfields, and the Brompton Hospital for Con- sumption. (2.) The Charing Cross Hospital is allowed to make use of the Royal Westminster Ophthalmic Hospital for ophthalmic cases, and for the instruction of students in that department. (3.) The physicians and surgeons of some of the London hospitals graduate to other hospitals, on the staff of which their own institution is already represen ted. Probably there are not a few other comparatively unimportant instances of partial co operation. That is the end of what we have to say about the hospitals and dispensaries being ill-grouped, Defect No. 9. Defect No. 10 is, “ There is no uniform system of keeping and publishing accounts.” I have myself examined the published accounts of nearly all the hospitals and dispensaries in the metropolis in drawing up this memorandum, and I think it would be evident to any investigator that the accounts are drawn up on very many different plans, so that it is im- possible to compare one hospital with another with any certainty of obtaining accurate results. In support of this I would again refer to Mr. Miehelli’s pamphlet; as a hospital secretary, he is specially cpualified to speak on this point: He says, “ I will now say a word or two about hospital accounts generally. Does not their publication at present almost amount to a farce ? The items of expenditure are jumbled up to- gether in a way that would confuse anyone. Investments are put down as expenditure ; certain receipts are not included under income, but are placed to a separate account; Conval- escent and Samaritan funds are often mixed up with other moneys. In one large Louden hos- pital this is carried to such an extent that the accounts are divided into no less than 11 dif- ferent statements. I waded through these for some time, but had to give it up, no definite deduction being in the least degree possible. Some hospitals publish no regular income and expenditure account; other s publish such ac- counts, but omit the balance sheet; whilst others, again, mix income and expenditure sheet and balance sheet together, forming a speeies of account that can only be intelligible, if at ail, to the innermost recesses of the author’s own mind; and very few publish any capital account at all. Almost all, however, make a statement that the cost per bed occupied has been so much, though not in one single instance have I been able to work out the figures. Something has been de- ducted or added to suit the taste of the official who prepared the statement, or of the manager he serves. The most general effect that seems to be striven for is to manufacture a deficiency where there is not one. The object of this is to make the accounts look as if the charity were in debt, and this is done in order that a piteous, but lying, appeal may be made to a sympathising but critical public. This is the reason ive frequently find C 2 so$