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affect this cost that deductions as to the efficiency or otherwise of hospital administration
must be drawn from the stated costs with caution.
The chief causes of variation in percentage occupation are :—
(i) Closing of wards or blocks for alterations or quarantine; degree of classification
of patients according to age or disease; extent to which wards are reserved
for certain types of cases.
(ii) Situation of hospital as regards locality, accessibility, proximity of other
municipal or voluntary hospitals.
(iii) Length of stay. This is the most important cause and it depends on many
factors which are not equally applicable to all hospitals. Some of these factors are:—
(a) The proportion of beds reserved for special types of cases, such as
plastic surgery, chronic sick and tuberculosis cases. The number of beds
normally occupied by maternity, surgical or medical cases.
(b) Facilities for transferring chronic sick easily and regularly from an
acute hospital to an appropriate chronic hospital.
(c) Facilities for transferring patients as soon as possible from acute to
convalescent hospitals.
(d) Facilities available in the district for home nursing of minor ailments;
in poor areas the number of admissions of such cases is greater than in better
circumstanced districts, and the average length of stay is shorter.
Salaries and wages of staff—
Salaries and wages account for about 50 per cent, of the cost of the average
hospital; in exceptional cases the proportion rises to 60 per cent. The amount
depends on two factors:—
(i) The number of staff in proportion to the number of patients and the
proportion of probationers and juniors to senior nursing and other staff.
(ii) The rates of pay of these various grades of staff.
The number of staff depends on:—
(a) The type of work done.
(b) The arrangement of wards and of the hospital generally as regards
convenience and ease of working.
(c) The standard set up or tradition followed in the past at the particular
hospital under consideration.
To a great extent these are not within local control. The prevailing rates of
pay are still less under local control.
Engineering and works services (including wages)—
Approximately 18 per cent. of the average weekly cost per patient is expended
on these services. The figures for various hospitals differ very markedly.
Costs of heating and lighting and maintenance of buildings depend on the layout,
the situation and surroundings of the hospital, the age of the fabric, and the
character and efficiency of the plant. The "works" figure depends on the amount
of reconstruction or improvement that has been undertaken. The number of maintenance
staff and rates of pay have also a bearing on these figures.
Cost of provisions, drugs and dressings—
The proportion of total cost in respect of provisions for patients, drugs and
dressings, while substantial is smaller than might be expected. On patients' food it
is under 11 per cent., excluding cooking and service. The amounts spent in the
various hospitals still show divergencies, but they are less marked than in previous
years. The average cost of drugs and dressings is about 3.6 per cent. of the total
cost.
The Cost Tables.
The introductory table A is designed to draw attention to certain factors
which influence, in varying degrees, the cost of treatment in hospitals. The factor of
percentage occupation, already referred to on p. 2 et seq., is important in its effect
on the average daily cost per patient, but the number of admissions and the average