PUBLIC HOSPITALS.

Auckland Star, Volume LVI, Issue 184, 6 August 1925, Page 7

PUBLIC HOSPITALS.

PRIVATE WARDS AND STAFFING.

B.M.A. RECOMMENDATIONS,

REPLY OF HOSPITAL BOARDS. ,

(By Telegraph.— Own Correspondent.) WELLINGTON, Wednesday.

The New Zealand branch of the British Medical Association recently published its recommendations on certain matters of policy in regard to public hospitals The recommendations have been considerd by the executive of the New Zealand Hospital Boards' Association, and formed the subject of a state-, ment made to-day by the president, Mr, William Wallace, of Auckland. The following is, in part, the reply of the executive of the Hospital Boards' Association to the 8.M.A.: — "From the viewpoint of the bulk of the medical profession the proposals may represent an ideal arrangement, but I do not think hospital boards or the public generally will regard them with favour. In the first place, it has been the experience of some boards that the placing of all the medical and surgical work in the hospital in the hands of the medical men in practice in the district has not been entirely satisfactory, mainly owing to the lack of disciplinary control and jurisdiction with the result that these boards have been compelled to appoint full-time stipendiary medical officers, and it has apparently been their experience that this is a much more satisfactory arrangement. It is not seen, moreover, how the present recommendation of the British Medical Association in this connection will afford any better means of exercising control over the visiting medical staff. On the contrary, its recommendation is clearly that the work should be in the irands of the medical practitioners entirely. Furthermore, even members of the profession are divided on the question as to whether surgical work in hospitals is not better left to medical men who have had the opportunity of obtaining considerable experience than to be distributed over medical practitioners in the district, only a few of whom will naturally have that opportunity. B.M.A. Suggestions. "The recommendations of the British Medical Association as regards the medical staffing of public hospitals as I understand them are, in eliect, that:— "(a) All the medical and surgical work of the hospital shall be in the hands of medical men in practice in x the district, under whose direction, however, the resident medical oflieers of tho institution may be permitted to act. "(b) Patients able to pay medical fees as well as hospital fees, and patients who voluntarily enter private wards, should be required to make arrangements for attendance by a doctor of their own choice, the fee to be a matter between patients and doctor. "(c) Patients other than those just referred to are to be attended by local practitioners appointed as part-time members of the hospital staff, and remunerated by the hospital board. In the ease of the smaller hospitals it is apparently intended that all local practitioners (except those deemed unsuitable by a proposed central controlling board) shall be appointed and given the right of attending their own patients if they so desire. "(d) Medical superintendents in the larger hospitals are to conline themselves to administrative work. "It will be noted that these recommendations resolve themselves into the support of a slight modification of the community system of hospitals, as operating in many eases in the hospitals in the United States, though 1 believe iv connection with only one or two ratesupported institutions." Summary of Policy. Having dealt at length with the proposals of the other matters in regard to medical staffing, the report summarised the recommendation of the executive of the Hospital Boards' Association in this, connection:— 1. That the hospitals are available to all who seek admission —the poor and destitute to have first right to the beds, and all that the medical practitioners should he concerned with is whether the physical condition of the patient is such as to make him a fit subject for hospital treatment, and whether he would benefit thereby. 2. That the principle is affirmed of providing private wards in public hospitals, patients voluntarily entering such wards to be at liberty to engage their own medical advisers. 3. The institution of private wards is a matter that should be left to each hospital board, -as also the question as to whether the boards should permit patients admitted to these private wards to obtain the services of the hoard's full-time medical officers in lieu of an outside practitioner. Where permission is not granted the board should preserve the right to approve a scale of fees that may be charged by outside, practitioners. 4. That the honorary staff cannot be expected to j;ive their services free, and should be remunerated. 5. That in no public wards should patients be attended by other than the medical staff appointed by the board. 6. That fees charged in the case of patients admitted to the public ward* should not- for the present be raised to more than 9/ per diem for adult-, with reductions for children. Patients admitted to private wards should be charged a fee estimated to cover tho full cost of maintenance, plus extras, and to include a proportion for depreciation charges, interest on capital, and administrative expenses. 7. That in all other matters of internal administration of the hospitals the executive is generally in accord with the model by-laws issued by the Department. 8. There should be no further subdivision of hospital districts, and anyfuture proposal in this direction should be referred to the executive of tho association. 1). The existing methods of levies and subsidies and of representation of contributor- local authorities should not be altered, except that the election of borough representatives should be triennial (instead of biennial;, as in the case of counties. 10. Social welfare work, including the administration of outdoor relief, is in its nature closely related to work iv connection with fees collection, and the treatment of the indigent sick in public hospitals, and is a proper function of hospital boards. _ _^__\_