Health dreams of the housewife

Press, Volume CXV, Issue 33750, 24 January 1975, Page 17

Health dreams of the housewife

(From GZENN HASZAi?D) LONDON. The dream of the housewife in New Zealand may be free medical care, but before embracing the concept she should take good note of the British experience.

Because the principle is essentially socialist and egalitarian, it is little wonder that New 1 Zealand's Labour Government should produce a White Paper which re-1’ fleets the policy already adopted by the British Labour Party. One good thing on which! New Zealand has followed Britain is the ideal of early consultation on such potentially flammable issues. In the next two years before it is legalised New Zealand’s housewives must sort out for themselves whether they really do want the soliaiist dream, for with it’ they must also accept its! shortcomings. ' * The first lesson to be learned from Britain is the i initial cost of reorganisation, j It has been estimated that it! cost Britain's taxpayers ■ £som for the change from: an administration very sim-j ilar to the present system in New Zealand to the system) which New Zealand’s White! Paper on Health envisages. Second, the reorganised! adminstrative set-up has ten-1 ded to take decision-making! away from the hearth ofi everyday action and cast it)! into the office of a distant bureaucract. Britain has a four-tiered hiert..chy with most of the decisions for a large com- '■ munity being taken by an area health authority.! ’’Below” . the area authority) is the network of hospitals and health centres, whose superintendents and other! heads continue their duties j of day-to-day supervision. but now have a considerably) reduced say in the priority) of financial allocation. Squeezed out Many, like the com-! paratively small Royal Lon-1 don Homeopathic Hospital, have found themselves being gradually squeezed out through a lack of funds, yet) powerless to do anything about it. ’ Above” the area author-; ity is the regional authority, I which allocates money to I rhe various areas under its' over-all supervision. In the nine months since) the reorganisation in Britain the regional authority has! found itself in an invidious, position, trying to calculate: just how much each area should be allocated. First attempts were made on the basis of previous ex-1

penditure by the sum total of all the constituent elements of the area — local authority clinics, hospitals, health centres etc. But in almost every case, partly because of inflation and partly because of numberous imponderable factors, i the areas found themsleves half way through 1974 and already in arrears. Officials expect more stability this year and in subsequent years, but they have experienced some frightening moments and New Zealand authorities can expect to share a similar anxiety. At the apex of the British hierarchy is of course the Department of Health, which spends more than £3OOO million a year keeping the National Health Service in its state of ill-health. The recent dispute between consultants and the ) Government brought forth) some rather unsavoury facts) about the state of Britain’s) health service. Consultants spoke of ! “slum conditions” in the I hospitals and there were rumours of mass emigrations (if the Government continued [to move in the direction of state control of all [health services. At present consultants can have private (patients. Building trouble Part of Britain’s troubles) i lies in the state of the build-1 Ings themselves. Only 41 of the 2300 hospitals are of (post-war construction. ! Another sorry state of affairs is that your everyday housewife here gets her free health service, but only after ’ waiting . . . and waiting . > . and waiting . . . Patients can wait for up to six years for a “minor” operation such a varicose iviens. The average waiting time for an eye operation is more than three months and for tonsils operations about six months. New Zealand should look, long and hard before deciding to do away with the! nominal charge for appoint-; ments with family doctors, j First, because it will place; (an extra burden on the I shoulders of the taxpayer. Second, because it will lead 'to abuses of the privilege. Queues In Britain family doctors) i and outpatient clinics have i Ito contend with queues of) patients, many of whom' have no other illness than! the inability to occupy their:

spare time. And the cause is not. just over-population. The tragedy is that genuine cases have to wait in the queue behind those who have no real medical problem at all.

The advantage of the present New Zealand system, although much-ma-ligned by the paying public, is that it sorts out the genuine cases from those who just come along to visit their doctor on the pretext of having something wrong with them.

In Britain the meetings of the area authorities are open to the public and the media, but with a high concentration of professional staff sitting at the meetings there has developed a language of medical and administrative jargon which is unfamiliar to all but the most regular of lay observers. This is unfortunate, for the health of a community is the concern not only of that small oligarchy of medical and paramedical people who attend monthly meetings. Meetings should not only be open to the public and media, but also conducted in a manner which is comprehensible.

Britain does not have “complaints commissioners” to deal with public problems, as is envisaged by the New Zealand Government in its White Paper. What Britain has, and which looks promising, is community health councils. Whereas the area and regional health authorities comprise people closely associated with health administration, the councils comprise people from local authorities and representatives of local welfare and voluntary health organisations.

The community health councils co-operate closely with area health authorities but are independent and not subservient. They have the right to inspect public health institutions and recommend changes. Their meetings are also open to the press and public. They have been called watchdogs on the authorities and mouthpieces for public viewpoints, but in practice they are ineffectual because they work on a tight budget and have no real power to ensure their recommendations are carried out or even considered.

I But at least they ensure [that the door is left halfjopen between the mysteries 'of the medical world and the : outside world of the house.wife.