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Financing of Hospitals

THE LANCETLONDON: SATURDAY, SEPT. 1, 1951

LEADING ARTICLES

HITHERTO the estimates of each hospital manage-ment committee for the year beginning in April havehad to be sent to the regional hospital board by thepreceding Sept. 30. They had to be submitted in greatdetail, often covering 150 pages or more. The date fortheir submission, coming so soon after the holidayseason, was highly inconvenient both for the com-mittees and for their officers, and often the variousitems could not be given the detailed considerationthey merited. Moreover the need to prepare theseestimates six months in advance of the starting-timemade them rather unrealistic. They were constructedwithout full knowledge of the current financial

expenditure, and also with the expectation-indeedthe certainty-that they would be arbitrarily cut, ifnot by the regional board then by the Ministry. (Suchdetailed budgets can in fact be critically dealt withonly by those who know the local conditions, and anycuts made by a central administration must thereforebe largely arbitrary.) The precise fate of these

extremely detailed hospital estimates on their arrivalat the Ministry has called forth some conjecture,for it seems unlikely that the bulky documents, from374 management committees and 36 boards of

governors, were read in full by anybody. Howeverthis may be, the management committees did notformally receive final. authority for their revisedestimates until well after the beginning of the financialyear. This meant that extraordinary items were heldup and were then submitted en masse to the com-mittee. Naturally, they were less critically examinedthan they would have been had they been spacedevenly over several meetings. This considerable delaymeant that, by the time some items were ordered,it was too late to get them delivered within thefinancial year, and they had to be budgeted again.

This financial structure imposed on hospitals byregulation s.i.1414 (Accounting and FinancialProvisions and Regulations) has been the despairof all critical members of management committeeswho wanted to infuse a spirit of enlightened economyinto their committees but were frustrated at everyturn by the procedure laid down. Hence we arethankful to note that new instructions have beenreceived [R.H.B.(51)84 H.M.C.(51)77] which shouldmuch improve the financial organisation for the

coming year. By Sept. 30, 1951, the managementcommittees will have to forward, not a detailedestimate, but merely a brief forecast, under certainheadings, of the amount required for the year 1952-53to operate the service at the level of developmentestimated to obtain on March 31, 1952 ; and a monthlater these will be sent on to the Ministry by theregional boards. By Jan. 15, 1952, after consultationswith representatives of the regional boards, the

Ministry will notify the boards of the total sums to beallocated to each region for 1952-53, subject to theultimate approval of the Government and Parliament.By Feb. 29, regional boards will notify their con-

stituent management committees of the total sumavailable for them for the following financial year,beginning on April 1. By March 31, committeesshould forward their detailed estimates for the year1952-53. (It is not clear why the regional boardsshould be allowed six weeks for their relatively simplesubdivision, against the four weeks for the detailedestimates by the management committees ; but in

practice much of the work of the committees willno doubt have been already performed.) On thisbasis it will for the first time be possible to produce adetailed estimate related to the actual level of expendi-ture, and competing claims will have been weighedone against another-a manoeuvre which is vital for acommon-sense economy but which has so far been

very difficult.The pleasure felt on receiving the new circulars

will have been somewhat lessened, however, by theobservation that an arbitrary cut has already beenfixed for 1952-53 : sums placed under the heading,Maintenance of Buildings, Plant, and Grounds, mustnot exceed 80% of the corresponding total for 1951-52. A major cut had previously been made under thisheading for the current year, and any further reductionmust often mean that preventive maintenancemeasures will be impossible, which not only is dis-

heartening to those who take a real interest in theirhospitals but must also in many instances prove afalse economy. With regard to capital expenditure,regional- boards are informed of the amount it is

hoped to make available for 1952-53 : the somewhat

meagre allocation varies from £240,000 to £800,000,representing a level of expenditure well below thatof pre-war days, but it has to be considered in thelight of the Defence programme. To give the regionalboards time to prepare a realistic programme for their

capital expenditure, their estimates will not have tobe submitted until Jan. 15, 1952.

It is to be hoped that in coming years, the pro-cedure will be still further simplified. There is reallyno need for the detailed estimates, which hinder, ratherthan assist, economy at the periphery. Items antici-

pated in the budget tend to pass the financial channelsunchallenged, whereas more urgent and often unpre-dictable items are held up. Hospital managementcommittees would function at their best if they feltthey had the full confidence of the Ministry ; and a

very simple estimate of their expenditure, under

major headings, is really all that is needed. Later we

may perhaps see the introduction of a system of"

departmental accounting " and global budgets of

the kind mentioned by a correspondent in his articleon p. 395.

Radioactive Isotopes for LocalisingBrain Tumours

IN 1913 GOLDMAN showed experimentally that anintravenous injection of the acid dye, trypan-blue,stams all tissues but brain. It was later found thatmost acid dyes do not penetrate the blood-brainbarrier (B.B.B.), and that the basic dyes which dopenetrate it are toxic ; adding sulpho-groups removestoxicity and penetrance together. In disease, however,the barrier is not always maintained ; and SORSBYand his colleagues 1 at St. Mary’s Hospital, London,1. Sorsby, A., Wright, A. D., Elkeles, A. Proc. R. Soc. Med. 1943,

36, 137.