Can Voluntary H ospitals Survive ?
VOR a number of years past the question has again I. and again been raised : Can the hospitals in London and other great cities continue to rely for support, as they have done for the most part up to now, on voluntary support ? If not, what is to be done ? Year by year the difficulties of the hospitals have increased. Now it seems that a point has been reached where some of them at any rate can no longer carry on under the present system.. One, the other day, was faced by need so urgent that it had to appeal to American generosity ; it secured a gift of £80,000 from Mr. Samuel Insull of Chicago. All honour to hirri, but where were our own rich men ? We cannot go to millionaires from the United States, hat in hand with a sob-story on our lips, whenever a hospital is being driven on to the rocks. If the stream of charity in this country is drying up—almost all hospital administrators say that it is—then some other method of maintaining these necessary institutions must be
looked for. It is not fair to those who struggle so desperately for adequate funds to look on and see them at frequent intervals so hard put to it that they know not where to turn.
This is no figure of speech, it is literal truth. There is one hospital at this moment which has cheques for goods supplied by tradesmen to the amount of £20,000 waiting to go out. They cannot go because there is not enough money in the bank to meet them. It may be that from some source at present out of sight this crisis will be liquidated. But the treasurer of that hospital knows that before long another will occur. And this is not an exceptional ease. No hospital can keep going without perpetual effort to get money ; very often the result is out of proportion to the energy expended. The very cost in cash of the campaigns that are now always with us reduces largely the totals which are added to the hospitals' resources. The utmost surprise (and in some quarters annoyance) was expressed when Birming- ham raised £250,000 at a cost of no more than £500.
Nor can the expedients sometimes adopted be seen with anything but regret by those who value dignity and hold that the care of the sick poor in a great city belonging to a great country should be managed without incessant rattling of tin boxes, and constant invasions of our streets by medical students in costumes of mas- • querade.
The greatest credit is due to the regular contributors, with a sense of trusteeship who figure in lists of hospital benefactors. Once it was possible to finance the hospitals- out of the yearly gifts and the legacies that steadily flowed in. Festival dinners were given which helped to raise large sums. Rich people felt it incumbent on them to " do their bit." Fine attempts have been made to fill the gap between income and expenditure. Hospital Saturday Fund, Hospital Sunday collections, King Edward's Hospital Fund, the Government gift of half a million a few years ago, all these have done something, but not enough. Most hopeful of all perhaps is the Hospital Savings Association which has already a membership approaching the million and which guarantees advice or treatment to all subscribers of 3d. a week. Along this line and in the paying ward which has become so general many students of the problem are inclined to look for, at all events, a partial solution.
The question then arises : How can the support of public authorities, whether national or local, the Treasury or County Councils, be best supplied ? A large body of opinion which has been until lately opposed to any change from the voluntary system is veering round to an attitude far less stiff and uncompromising. There are stlil a great many people who say that-change must he avoided somehow or other, but they do not tell the hard-pressed hospital treasurers and secretaries how the voluntary contributions are to be brought up to the required level. It is these officials who bear the burden and heat of the day ; many among them are thinking about public aid as a " necessary evil " or perhaps not an evil at all if the terms on which it is given can be amicably arranged.
The general idea seems to be that any service or set of institutions for which the community makes itself responsible must undergo complete transformation. There arc examples to the contrary on every hand. Assistance from public funds is received by many concerns which are self-governing except for some inspection or some representation of the public on their governing bodies. For example, the University of London is subsidized in this way, both by the State and by the London County Council. Why should not the hospitals be treated in the same fashion ? They would then continue to be managed as they are now—by men and women who give their services and who could continue to raise a certain amount of money from voluntary contributors, their activities being watched by the Ministry of Health, which could interfere when necessary, and their com- mittees including members appointed by the Minister or
by the County Councils. This would avoid a break between the hospitals as we know (and value) them and hospitals that will form part of the community health service. Some escape from the present unsatisfactory, indeed, impossible position must be found.
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