8.—4 a,

considerations which outweigh the advantages of immediate amalgamation. For instance, the Mines Department should ultimately be amalgamated with the Public Works Department, more particularly if the latter Department be reduced in size as a result of our recommendations. This amalgamation should be then effected. 58. It should also be possible at some future date to amalgamate the Forestry Department with the Department of Lands and Survey, although here again we do not recommend immediate amalgamation. When the Forestry Department is reduced to a purely maintenance basis there should be no obstacle in the way of amalgamation. 59. Finally, we consider that, under a suitable administrative officer, the Department of Lands and Survey and the Department of Agriculture should be amalgamated. They have common interests, and if effective amalgamation can be arranged in the future the resulting establishment should be much more economical than the present Departments. A very considerable saving would result from the unification of the field staffs of the two Departments. HOSPITALS AND CHARITABLE INSTITUTIONS ACT, 1926. Subsidies to Hospital Boards. 60. We have already touched in our interim report upon the question of subsidies to Hospital Boards, and after recommending that subsidies for both capital and maintenance purposes heretofore paid under permanent appropriations should be subject to annual review by Parliament, we stated that we had not considered the possibility of effecting economies under this heading, and that this aspect would be dealt with in our final report. 61. We have now carefully considered the whole question of hospital administration, and the cost both to the Consolidated Fund and by way of local rates. It appears that under the present system of hospital administration substantial relief to the Consolidated Fund by way of reduction of subsidy to Hospital Boards must result in increasing the burden of local rates. This would simply be a redistribution of costs without any true national economy, and, as the steadily increasing demands on the public purse both through local rates and general taxation indicate that the present hospital system has become unduly expensive, we have accordingly considered the whole question with a view to recommending reorganization. 62. The following statement, showing how the expenditure on hospitals and charitable aid has grown since 1914-15, will emphasize the need for reform : —

Hospitals Boards. —Summary of Expenditure, Years 1913-14 to 1930-31.

63. It is unnecessary to traverse in detail the early history of hospital institutions, but apparently hospital districts were for the first time constituted by the Hospitals Bill introduced in 1885. In that year the system of local-body control was clearly defined, and Hospital Boards were subsidized both for capital and maintenance at the rate of £1 for £1 by the Government. It was not until 1909 that further reform, which was long overdue, was attempted, and the Act passed in that year met with considerable opposition from those bodies which were superseded. By this Act one Hospital and Charitable Aid Board for each district was constituted, and the system of separate institutions was practically abolished. Under the Act and subsequent amendments forty-seven hospital districts were established, and forty-five districts exist to-day. The system of control by Boards elected by the electors of the various contributory authorities is probably well known, and need not be enlarged upon. The main

9

(Excluding hospitals under the care of the Department.) Charitable Belief. » § § s> J »1 5 3%«* ■ Year Medical § 8gs ts Tnfprpsi- -a § ° • Total n ■* i Total of both ,g g o ended Hospital Assooia- District 3 I gig S nn !l£a Maintenance Maintenance £ § &«•§ «onsor Nll ,,n, | ||| | ||«| «£— H^ d , J gg J |||| Indoor. Outdoor. | | f.2 I'a^ftS 15 a g i • j £ £ £j£ ££££££ £ £ £ £ s. d. 1914 249,910 61,431 33,304 2,745 2,890 * 18,056 21,323 3,007 .. 392,666 140,841 533,507 0 9 4 1915 268,694 66,557 36,019 2,233 4,775 * 14,556 22,862 3,430 .. 419,126 115,279 534,405 0 9 3 1916 310,643 75,511 38,947 1,595 3,437 * 17,542 25,755 8,083 .. 481,513 106,006 587,519 0 10 2 1917 352,527 72,524 41,119 1,088 2,193 * 49,379 25,474 8,545 .. 552,849 86,322 639,171 0 11 1 1918 425,635 81,841 43,269 1,565 2,788 * 57,941 27,731 7,646 .. 648,416 125,271 773,687 0 13 5 1919 508,692 79,651 52,653 1,495 2,323 * 27,271 29,837 12,528 .. 714,450 156,440 870,890 0 14 10 1920 596,568 85,719 81,749 1,411 3,045 * 35,619 36,186 20,592 .. 860,889 188,602 1,049,491 0 17 0 1921 693,243 95,068 87,695 2,047 5,125 * 23,903 41,031 26,350 .. 974,462 174,225 1,148,687 0 18 1 1922 735,391 103,639 80,828 ' 2,766 4,308 * 16,417 47,964 26,223 .. 1,017,536 175,091 1,192,627 0 18 4 1923 743,208 86,873 75,911 3,873 5,217 * 20,971 49,227 26,132 .. 1,011,412 135,571 1,146,983 0 17 4 1924 789,682 91,572 76,069 4,979 5,665 3,486 20,199 52,251 30,345 .. 1,074,248 213,982 1,288,230 0 19 1 1925 850,188 94,756 76,190 7,453 6,291 3,836 15,285 58,578 38,569 .. 1,151,146 420,657 1,571,803 1 2 9 1926 924 612 101,221 77,599 8,579 5,987 4,570 15,074 66,793 52,215 .. 1,256,650 577,619 1,834,269 1 6 0 1927 981,789 112,726 92,922 10,370 9,260 5,072 22,383 69,392 65,748 20,985 1,390,647 417,946 1,808,593 1 5 3 1928 1,021,585 112,755 112,519 9,740 9,588 7,031 10,815 72,398 84,181 23,038 1,463,650 350,879 1,814,529 1 5 1 1929 1,092,392 110,874 134,864 10,336 9,856 7,311 10,762 71,409 84,006 18,500 1,550,310 205,422 1,755,732 1 4 0 1930 1,130,400 114,532 140,065 11,800 9,867 8,177 6,987 74,859 81,191 17,432 1,595,310 171,150 1,766,460 1 3 10 1931 1,143,659 119,774 192,073 11,877 9,830 8,727 10,592 76,037 85,226 19,274 1,677,069 253,585 1,930,654 1 5 10 * Included under hospital maintenance.