Eleventh report from the Select Committee on Estimates : together with the minutes of evidence taken before sub-committee E and appendices, session 1950-1951: regional hospital boards and hospital management committees.
- Great Britain. Parliament. House of Commons. Select Committee on Estimates
- Date:
- [1951]
Licence: Public Domain Mark
Credit: Eleventh report from the Select Committee on Estimates : together with the minutes of evidence taken before sub-committee E and appendices, session 1950-1951: regional hospital boards and hospital management committees. Source: Wellcome Collection.
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![25 January, 1951.] [Continued. staff which will be necessary to run it. If you have local buying you have your staff on the spot coping with it, as they always have done. If you have central buying you have to have a central office with all its attendant personnel. The economies are often not considerable, and the possibility of getting large masses of material centrally is often small, whereas local purchase, being for much smaller quantities, is possible. There are many objections to it, but on the ground of economy the feeling of many people is that it is not in the end going to lead to decreased expenditure, but probably to increased expenditure with a decrease of efficiency because local conditions are not capable of being taken into account adequately by that method. While I have only spoken on this aspect, detail in such matters is being required in all kinds of other ways. The best instance perhaps I can give you is what resulted from the sending out of an instruction under a wrong number. 215. Again I think administration? —Yes, Sir. this is general 216. If you are relating this to the central purchasing of medical equipment or some- thing of that sort it is all right, but | am rather anxious not to bring in general administration?—I will say no more on that aspect. The only thing I would say finally is that my criticism of such a system would be that it involves a great increase of personnel. I do not know whether any facts exist as to the increase of administra- tion personnel in hospitals since July, 1948, but it is my recollection Chairman.] 1 wanted to ask about that later. Mr. Diamond. 217. In regard to this question of block grants the last sentence in your memor- andum reads “At present, inefficiency results from capital and maintenance expenditure having to be enclosed within one annual budget”. I do not quite follow that, and I wonder if I could ask you for clarification? —(Dr. Rowland Hill.) Capital expenditure above a certain sum of money in the case of non-teaching hospitals is the responsibility of the regional board, but the regional. board, so I am given to under- stand by our professional colleagues who are concerned with these matters, cannot spread its capital plans over a period of years. The capital plans of a regional board have to be compressed within a year’s estimate, and of course in hospital work many capital expenditures should be quite long term spread over a number of years. It occurred to us from our point of view as doctors that some of the things which we desire to see increased in our hospitals would be helped if the capital budget were one which could be a five years’ budget, for example, as distinct from an annual budget. 218. Do you mean divided into five yearly amounts, or just one amount spent at any time within a period of five years? —More or less the latter part, not having an estimate of how much of it should go each year. Of course we do not wish to speak as experts on that matter, but only as doctors concerned with certain medical capital . plans. ; Chairman. 219. You are obviously vitally concerned there?—(Professor Hartfall.) We find in this connection that towards the end of the financial year our hospital has a certain amount of money which it is anxious to spend ; whereas at the beginning of the year we may have difficulty in getting certain equipment through, towards the end of the year we are almost being persuaded to buy it in order that we shall spend up to our budget. Mr. J. Enoch Powell. 220. I take it the essence of a block grant as recommended is that a fixed sum, not expected to be altered, is promised for a certain number of years ahead. A block grant for one year is meaningless?—(Dr. Rowland Hill.) Exactly. 221. It must be a block grant guaranteed for a number of years, say five years ahead, in order to produce the advantages which you desire to see?—Yes. 222. Would the British Medical Associa- tion be prepared to accept the disadvantages in that system, namely that, instead of looking at the development of a scheme year by year and making financial provision for it, one takes a five year view? You accept the cramping as well as the advan- tages because clearly, if it is altered every year, it is not a block grant and you lose all the advantages anticipated?—-I am sure our profession, knowing the way in which medicine has developed, not in sudden spurts but by steady evolution, would prefer a long term financial arrangement. Mr. Thomas Reid. 223. Supposing an area had drawn up a programme for five years, I presume it would include very often very heavy capital expenditure?—Yes. 224. Therefore you would be asking the Minister—not merely you but all the other regions—to commit himself to a very huge expenditure for five years. Suppose a war then intervene ; there are war finances, and the Minister is in difficulties; perhaps the Chancellor of the Exchequer cannot find the money?—I suppose in: one sense we are all living from year to year, or even perhaps](https://iiif.wellcomecollection.org/image/b32182478_0060.jp2/full/800%2C/0/default.jpg)
