Chromosome mapping.

instance, is nearly £15 a week and East Anglia's is £14 12s. 4d. Conversely, at £12 8s. 4d. the Liverpool region's is less than the national average of £13 13s. 4d. But the cost per inpatient week is only one aspect of the financial picture. A better measurement of efficiency for acute hospitals-and all the figures given here have been for this type of hospital-is the cost per inpatient case, calculated by dividing inpatient expenditure by the total number of discharges and deaths. Hospitals that, by reducing the length of stay, can treat more patients show a lower cost per case. To some extent, therefore, hospital regions with high staff costs show a low cost per case because they are able to discharge patients more quickly. Oxford's cost per case, for instance, is the lowest, at just below £69 compared with a national average of £82 lOs. 2d. , and the length of stay in that region is only eight days compared with a national average of 10-4 days. Similarly, the region with the highest cost per case (nearly £93) is the South-west Metropolitan. It not only has a comparatively high weekly cost for maintaining inpatients, because its staff bill is higher than the average, but also keeps them in hospital for just over 11 days. The average length of stay in hospital over the country as a whole was lower by a day and a half in 1969-70 than five years previously, a trend that means that the increase in the cost per case rose by just under 8% last year, compared with the rise of 101% in weekly maintenance costs. Here is an aspect of financial management that directly concerns doctors. But it is not the only aspect. Both at the Cogwheel-Salmon conference held at Church House recently2 and at a conference on management accounting sponsored by the King's Fund at the Hospital Centre last week hospital administrators and treasurers urged that doctors-not only senior doctors-should take a greater increase in management, for which costing is one tool. The new costing returns are for the year 1969-70, and are therefore published ten months after the event, after budgets have been fixed for the coming financial year, 1971-2, and after treasurers have begun to frame their estimates for 1972-3. Last week hospital treasurers, a few of whom at the suggestion of the King's Fund have been experimenting with departmental costing3 throughout the year, strongly recommended that monthly costing returns should be adopted in all hospitals and that the monthly returns of expenditure under subjective headings (manpower, food, drugs, heating, lighting, etc.), unrelated to departments, should be dropped. The present financial returns, it was pointed out, merely show whether hospitals are keeping within their allocations, not whether the money is being spent on the right things; nor do they show changes in work load and the consequent need to transfer resources from one department to another. The present form of costing is not, of course, the last word in management accounting. Some hospitals are going much farther and have adopted functional budgeting. They provide budgets for medical and surgical services, nursing services, laboratories, engineering, supplies, and catering for a whole group and give the heads of departments responsibility for spending them. The Department of Health is apparently sympathetic towards the new outlook on management, and, provided the Treasury agrees, the old system of subjective accounting may be dropped. In any case doctors, who after all initiate expenditure, cannot continue to remain aloof from management.