PUBLIC HEALTH

Dominion, Volume 12, Issue 149, 19 March 1919, Page 8

PUBLIC HEALTH

DR. MAKGILL'S CRITICISMS

MINISTER IS INDIGNANT

STATEMENT TO COMMISSION

BLAME LAID ON OFFICERS

A DEFENCE OF THE BOARD

It was. not to be expected that the Minister of Public Health would allow to pass unnoticed the very free criticism of the Department given to the Epidemic Commission' on Monday by Dr. Makgill, u senior officer of the Department, speaking for his colleagues as well as for himself. The Minister (the Hon. G. WRussell) appeared before the Commission yesterday with a statement in reply to Dr. Makgill. The Minister said that the evidence had been brought under his notice. Tho mutter had been considered by Cabinet, and he had been instructed to make a statement. The statement made, by the Minister, however, was not the. statement of Cabinet, but a statement, of the Minister. Policy. "My attention has been directed," said the Minister, ''to the evidence given before the Commission yesterday by Dr. Makgill, an officer of tho Public Health Department, who informed the Commission that, the evidence had been prepared in consultation with his colleagues, and that it did not express merely his own opinion. T have to express regret that this evidence was not given prior to that given by me. The statement in question generally traverses the political side of the control of tho Public Health Department, and tile question was asked: 'Was tho Public Health Department to be merely an advisory body? If so, it should have no mandatory powers and no responsibilities in local government.' With reference to this aspect, it is necessary to understand that the policy upon which the legislation of New Zealand has been built in all respects is that of government by the people themselves, and the State assumes control only in such matters as it is necessary for the interests of the State. For example, the Railways Department is a purely State function. The Education Department, while financed by the Government, is, on the other hand, broken up into education boards, secondary school hoards, education boards and school committees for primary, boards of governors for secondary schools and colleges, and the Senate as the overruling hotly for university education. In exactly the same way the object in -public health has been, as far as possible, to throw the responsibilities upon the people themselves through the local authorities. It is not the policy of this or any Government io take away from tho functions of city councils and other local bodies, hut jathcr to enlarge those functions and to employ the' Public Health Department, as far as possible, as an advisory and supervising authority. Status of the Department. "The statement is further wade 'that the status of the Department is therefore most unsatisfactory. It lacks powers where powers are most needed. It possesses powers in theory which cannot bo exercised in practice, and its functions are directly controlled bv a Ministry devoid of expert knowledge.' It is difficult lo know exactly what is meant by tho remarks that aro made. If they suggest that the entire miblic service of the country, including the sanitation of the cities and work which now properly devolves upon the local authorities should be assumed by the State, the answer is that such a proposal r-ould only ho made by men who are totally unacquainted with the genius of our race, which properly and legitimately insists upon control by properly-constituted governing authorities of all functions and ptiwers which can legitimately he placed within their hands. Tho idea of the Public Health Department os-urnim; .•>>iylliin.'j more than supervising authority and powers of direction iP'-ardin? sanitations, drainage, etc., would be too ridiculous for words. "In some respects the Department has very real control. For example, under the Public Health Amendment Act the Minister has power lo order a local authority to ihstal a system of drainage, or, if necessary, to nive authority to tho local body for the installation of a system of drainage without the necessity "of taking a poll from the ratepayers. This js a very real safeguard, and," of course, is always exercised onlv upon the advice of tho Chief Health Cfficer.' What Dr, Makgill Said, "The statement is made: 'At times a political aspirant finds it useful to arouse passing interest in Some branch of public health, and to this end some simple facts .will be decked in lurid colours to attract attention. But his interest in the subject soon ceases, and the public, pacified by the discovery of yne deception, sinks back into peaceful indifference. Sanitary progress can onlv be secured by taking public health out of tho sphere of politics, and bv establishing a, continuity of policy of which one item should be the education of the public to seek after sanitary righteousness. To this end- it is necessary lo establish a strong controlling body representing various grades of public' opinion and seasoned by a liberafadmixttire of expert knowledge in the sciences and trades with which sanitary work is most directly concerned. In the Public Health Amendment Act of 11)18, clause 2, an attempt has been made to establish 'such a body by the creation of a Board of Public Health. Unfortunately, when we examine into tho powers of this board we find that they aro merely an advisory board rOporting to Ihe Minister their opinions on public health questions. The Board cannot direct 11 e enforcement of any sanitary works, cannot initiate precautions, cannot bring pressure to bear on local bodies or give directions to the Departmental officers. Their recommendations go to tho Minister, and thus aro subject to those political considerations inseparable from Cabinet control. In the same Act district advisor;' boards may be constituted by the Minister. Their function is to report on matters which ho may refer to them—a. variety of sanitary debating club, in fnoi, to whom subjects for discussion will be ul-l-itted, jind whoso resolutions may be duly pigeonholed if they run contrary lo popular prejudice or are otherwise inconvenient. Little cf value need be anticipated from the creation of those bodies as at present constituted.' Minister Defends tho Board, "Passing over the political references herein, I wish to fake the strongest exception to the statements herein made with regard to tho Board of Health established by the Public Health Amendment Act, 1918, and which by a most unlucky fortuity of circumstances holds its first meeting to-day for the purpose of completing what measures are :\pcessnry in view of a possible recrudescence of the epidemic. I may say that this board has been appointed exactly on tho lines of the Council of Education as provided in sections 8-10 of the Education Act, 1911. and a further precedent is the Board of Agriculture appointed under the Board of Agriculture "Act, 1913. Tf the members of tho Commission will compare the Council of Education and ils powers with those placed nnon the Public Health Board in clause 2 of (lie Public Ilnnltli Amendment Act. JO/,s', they will see how closely the lejislnlion i>> concoction with education has been followed.

"I ivill now inpii|iii:i 1 he iht'oiiw) of the Uonvil: —The Minister nf I'ub'i't JKilili is chairman, tliii Cliii'f Fpaltli Officer, President of (lie British Medical Association for New tfpaland, Dean of the Fnrnlly of Medicine in the Citato University, and ndicr in champ of local government in (in; Interna! Affairs Department. The other fivn im.mbcrs cnniprise Br. Cordon', u leading nir.licnl practitioner in Auckland, Mr. William Ferguson, chairman of tlin National Efficiency Board, the Hon. W. ][. Triggs, M.L.C., of. Cliristchurch, the

Hon. John Bavr, M.L.C., to represent Labour, and sir. nurst Senger, tho loading authority of New Zealand upon town planning.' Mr. Hurst Scag.cr and the officer in charge of local government in the Department of interna! Affairs, have been brought in in connection with the town-planning responsibilities which are laid .IiDOU the Department. "If "tli? Commission will look at Clause 11 of the Amendment Act. 191 S. thev will see that in connection with insanitary areas very large responsibilities are'laid upon the Board of Health. Under certain circumstances they are reciuired to hold a public inquiry and transmit their report to the Minister o Health, forwarding a copy to the local authority. Thus are very important responsibilities laid upon (he Board of Health in connection with Inoinsniutnry areas in our citus. I think the personnel of the Board of. Hon th completely iustifies my assertion that that board' will not be n useless body. Un the contrary, the ability and. experience of the gentlemen who form it will, m my opinion, be of the greatest ya no to the Government in connection with mailers relating to the general health of the Dominion.

The "Sanitary Debating Clubs." "In exactly the same way the district advisory committees which are provided for, aiid which are contemptuously referred to by the Departmental officers ns 'a variety of sanitary debating clubs, an expression which I think is most olfensive, are to consist ot five members, with a district health olliccr, wlis shall be chairman,- and the president ot tho B.M.A. for the district, as ex-olhcio members, while I trust the other three will be comprised of the i-layor. the chairman of tho Hospital itoml. ad president of tho Trades and Labour Council, or a direct representative of Laboui. These gentlemen, when constituted an advisory hoard with regard to sjnttcw of local health arising out of sanitation, housing, food conditions and similar matters, will lie of the greatest assistance to the Government. To describe such a bodv, when constituted, as 'a. variety ot sanitary debating club" is, in my opinion, not worthy of the Departmental officers 'who prepared tho wet which Dr. Makgill placed before tho Umnibsion. Throughout tho whole of the evidence there are improper allusions to tlio political side of tho Departments work, which I exceedingly regret to observe.

People Would Not Have It. "Tho idea, according to Ihe Departmental officers, is ttiat 'the controlling body should bo a lwn-pohtical board ot health composed of persons with experience and expert knowledge, wnose actions and decisions will be lounded on scientific laws and actuated by f tlio practical needs of the community. "In so far as these rellections reflect upon myself and previous Ministers of Ifcalth, they are unworthy of serious notice. If tho idea of the Departmental officers is to establish a public health authority of a bureaucratic character, in which they will be able to act without tho control of the people as represented by Parliament, and without the control of Parliament as represented by Cabinet and the Ministerial head they have still a great deal to learn about the couniry in which they live. Tho people of New Zealand would-never for 0110 moment tolerate the establishment of a bureaucratic system as regards health or any other subject. (In a previous occasion thoro was a Kailway Commission which controlled the railways. Thev were displaced, and it is unthinkable that the Government should hand over to Departmental officers the huge responsibilities, financial and otherwise, that- would be entailed in the proposal submitted to the Commission.

"It is suggested that 'doubtless a Minister, of Health is needed to report tho claims of sanitation to Cabinet and to Parliament; Tho general expenditure must bo thus controlled, as also . (he amendments and additions to sanitary legislation. But here his functions should end, and the real controlling authority should be a non-political board of health composed of persons with experience and expert knowledge, whose actions and decisions will bo founded on scientific laws and actuated by the practical needs of the community.' Tho answer to that is that sucli a body has been established in the Public Health Board. "Aimed at Myself." ''It is not necessary for me to point out the importance of the Minister of Public Health being associated with a board whose proposals may require that he should havoa thorough knowledge of I hem in order to ewrry them through Cabinet. Now, what is the present position? It is an unwritten law that no new -expemiituro involving a sum of over £150 can be made byaa Minister unless it is first approved by Cabinet. That is the sheet anchor against, incompetent control, and invariably it is on flin advice of his expert officers that Hie Minister acls in these matters. Sometimes there may bo a difference of opinion between the Minister and his chief adviser. In that case, of course, tho Ministerial decision stands. It is impossible for mon not to regard the attack upon Ministerial control which is being made by the Department as aimecf at myself. I have now been Minister of Public Health on two occasions, lirst in the Government of 1912, and secondly in tho present Government for nearly four years. No proposal, has ever been submitted lo me by the Department that would go in the direction of improving the public health service of tho country and been turned down. The salaries have been referred to. In this connection I Imve to say that several of tho salaries, of (he higher officers hnvo been raised while I have been 11 inister. There may havo been more Ministerial, initiative than the Department cared about. Amongst those matters which have depended upon Ministerial initiative are the following:— ' |

"I. Extension of the St. Helens Homo system at Gisborno .and Invereargill, uml creation of Maternity Hospitals ami wards at Napier, Blenheim, and other places. The policy of urging the hospital boards to create maternity wards has been a Ministerial policy, not a Departmental one. "2. The establishment of medical bursaries at the Otago University for the purpose of providing assistant house surgeons for our hospitals. "3. The establishment of dental bursaries. "i. The encouragement and extension of the Plunked nurses. "5. The extension of the Public Health Service by tho Public Health Amend-' went Act, 1918, to country districts as well as our cities. "G. Tho establishment of a Board' of Health. • Minister Charges the Officers. "There has never 'been any desire or intention on the part of tho Minister to interfere with the scientific, experimental, or technical sides of (he Department, except, as I stated in my evidence a few days ago, the wish to malic a line of demarcation as regards (he b*- l $ -' tho Department aud district health officers between the purely fcientnu- and lay work. If the Department is, therefore, in n backward state as iregards organisation, efficiency, and ability to meet the public health conditions arising out of tho epidemics and such untoward events, tho responsibility rests upon the heads of that Department to show to the Commission and to tho people of the country that they have mado recommendations wihch would hnvo stopped the leaks, that they have asked for money which has been refused, and, in fact, that they are not themselves rn. sponsiblo for the condition against which they complain. To sneer at Ministers as 'politicians, and to say that 'politicians reflect the popular wishes rather than scientific, needs' is a very cheap and easy way for the men whom the Government have paid to advise with regard to public health to escape the responsibility that vests upon (hem. "[' repent without any hesitation that if nt any time during the years 1 have held office the Departmental lu'iitis had made mid forwarded In inc lcommenda(iuns with regard to the ilium vemeiit of I lie service, the alteration i:f the law, the raising of salaries, their suggestions would" have been brought before Cabinet; upon which would have rested the responsibility of inaction. JCo such recommendations have been ma' 1 ". «'"' '""' "•" Miiditioii, therefore, of the Deportment l.'j-iliiv. the responsibility rests, mi,, i.,... the Government, but upon the Departmental officers, who Imve itiiii'irci.Hv solved their consciences by preparing the statement which has 'been laid beloru u. Commission." When II r. Russell had concluded. J

Sir John Denniston said that as to the lima when tho evidence of Dr. Makgill was taken, the timo was fixed by (he Ccmmission, and not by tho witness. As to the matter of tho evidence: given, tho Commission had asked for a lull and frank expression of opinion from the ohiccis el the Department. Dr. Makgill's stateine:it had been a sencr.il expression of tho views of tho Department, and it had no reference to persons. It was a general expression of opinion in die abstract on the activities of tho .Department without regard to.tho existing Minister or the existing board. As to how iar tho opinions were correct, he (Sir John Dennsloi.; could not at present givofiio opinion.

The Minister replied that Cabinet consisted of thirteen gentlemen, all of whom were politicians, and whether the referents wero personal or not, it was impossible for (ho Government to accept a statement which although given in the abstract was a general criticism of the Government.