HOSPITAL SYSTEM

Evening Post, Volume CXII, Issue 18, 21 July 1926, Page 3

HOSPITAL SYSTEM

ATTITUDE OF B.M.A

MINISTER'S DECLARATION

-PRESENT POLICY TO BE ADHERED TO. Tho public hospital system of the Dominion ;ind tho attitude of the British Medical Association towards it were discussed when the Hospital and Charitable Institutions Bill came up for second reading in the House of Representatives last night. In replying to the discussion, the Minister stated that the present democratic system of^ hospital control was to be retained. Tho Minister of Health (the Hon. J. A. Young) said that the Bill contained no new law. It was merely a compilation of all the statutes relating to hospitals. Mr. M. J. Savage (Auckland West) said an attempt had been made to break down the New Zealand hospitals. He intended to try to prove that represenfatives'on the British Medical Association went to U.S.A. and advocated certain principles that were largely contained in the report of Dr. MacEachern. He quoted extracts from speeches made in America by Sir Lindo Ferguson and Drs. J. S. Elliott and Falconer, in which he claimed that they showed a tendency towards desiring a different method in running the New Zealand hospitals. Speaking at a conference in Now York, held under the auspices of the American College of. Surgeons, Sir Lindo Ferguson had stated that when he got back to New Zealand he would make every effort to get the whole of the treatment of the' sick taken over by the University. Mr. Savage quoted remarks delivered in America by Dr. Elliott, who, he said, seemed to believe that charity should be one of the fundamentals of the New Zealand hospital system. Ho had spoken in America in favour of private enterprise in connection with hospitals. He had also stated that in the event of the honorary staffs going on strike, as it were, the Government would pay a staff and let them do the work. Mr. Savage resented the imputation contained in one of Dr. Elliott's American speeches, that the average patient in the hospital belonged to the "wastrel or the sponging class." The speaker next quoted extracts from the report of Dr. MaeEaehern, and said that in connection with the membership of hospital boards, the suggestion was that wo should have the nominative method instead of the elective. Dealing with the paying ward recommendation, Mr. Savage said that New Zealand hospitals had always been accessible to anybody. The aim was to make tho hospitals a happy hunting-ground for members of the British Medical Association, but the bulk of the members of the British Medical Association would not endorse that.

Sir Maui Pomare: "How do you know?"

Mr. Savage said he did know, and had discussed the question with members of the British Medical Association. He would liko to see a referendum taken on the question. To sum up, Mr. Savage said that three members of the British Medical Association, at a conference in New York in 1924, had advocated the principles contained in Dr. MaeEaehern's report. "In 1926," he said, "I find a medical gentleman perambulating through New Zealand, getting more publicity than the Prime Minister, and making a report containing the very fundamentals advocated by members of the New Zealand branch of the British Medical Association. Here I am wondering what the Government is going to do about it. It has been said that Dr. MaeEaehern was brought here by the British Medical Association, and I want to pay my tribute to tho Minister on tho attitude he has taken. He has made it quite clear to me at least whero he stands in the matter, but I am wondering what we can expect in the future. Here wa have propaganda put forward by a propagandist—who, by the way, is not the world authority we were led to believe Dr. MaeEaehern was, but representing a propagandist institution— in order to inflict principles upon New Zealand that would mean a breakdown of tho hospital system."

UNDER THE PEOPLE'S CONTROL.

Sir John Luke (Wellington North) thought the Minister should explain the hospital and charitable aid system, and what the Government had in mind. He did not take a gloomy view and he did not think the Government would bring in a system under which the hospitals would be governed by the medical men. Sir John paid a tribute to the generosity of the medical profession, and said he would hail anything that would put the hospitals on a bettor footing, although he maintained that they should be kept under the direct control of the people. He was sorry Mr. Savage had spoken disparagingly of Dr. MaeEaehern. "God bless my soul," exclaimed Sir John, "let us get tho ideas we can, no matter whether they are from America or anywhere else." Dealings with the increased cost of hospital administration, Sir John said he thought the hospital hoards had always sought to preserve the well-being of the patients. Many additional services had been placed upon the shoulders of the hospitals to carry out, such as dental clinics, T.B. sanatoria, and convalescent homes, and these had all meant extra cost. Such services, however, were a vital necessity to-day. Sir John said the Bill, being a consolidating measure, would repeal fifteen other enactments, and thus make for clearer administration on the part of the hospital boards. He did not think there need be objection to tho private ward system, where special attention was required, but he did object to having a lot of cubicles in a hospital. If a man was prepared to pay for a special ward he should be allowed to do so. NO DISCRIMINATION. The .Right Hon. Sir Joseph Ward (Invercargill) largely agreed with the views of Mr. Savage, and said he favoured the New Zealand system, which was one of the best in the world. All \he people in the Dominion were contributing to tho support of the hospitals, directly or indirectly. He did not believe in making distinctions between rich and poor in the hospitals; neither did ho believe in the British subscriber system, which would give the man of means an advantage. Sir Joseph said that medical men wero often very generous to people who could not afford to pay. Simply because a few members of the B.M.A. had made a recommendation he would not liko to see any attempt made to alter the system in operation in the country. He would like to see

maintained the right of the poorest person to obtain the most skilled attention the hospitals could give. "If you discriminate and give one person the right to a room on payment you should give everyone a room on payment," said Sir Joseph, "and then it is a question of who has the longest purse." There were any amount of nursing homos, and the hospitals gave splendid service. Mr. W. D. Lysnar (Gisborne) advocated a system whereby the hospital boards could levy rates direct. They would thus be made responsible to the ratepayers direct. It would bo bettor for the hospital boards to explain their levies direct to the public instead of doing it through other bodies. He agreed with what Mr. Savage had said about preserving tho present system of election of members of hospital boards. Where a person was prepared to pay he should have the right to a private room, although the treatment should be tho same as was given to other patients. Mr. P. Eraser (Wellington Central): "And his own doctor?" Mr. Lysnar said ho would agree to that. ✓ The Loader of the Opposition (Mr.' 11. E. Holland): "And his own nurse." (Laughter.) "No; tho nurse must be part of the institution," replied Mr. Lysnar. Mr. Fraser: "Who is going to control the outside doctor." "'•. Lysnar: "The patients." (Laughter.) .■__ HELP FROM CONSOLIDATED FUND. Mr. D. G. Sullivan (Avon) urged tho Government to consider the necessity of throwing a larger proportion of the cost of hospital administration on to the Consolidated Fund instead, of making the local rates carry 50 per cent, of the burden. As things were, there were many wealthy people whe did not contribute their fair share towards the cost of hospital administration. As Sir Joseph Ward had pointed out, ratepayers paid direct to tho" cost of administration, and again, indirectly, through tho Customs. Ho maintained that a real attempt was being made by certain medical men to obtain control of tho hospitals, and stated that a well-known doctor had told him that tho time had come when that should be done. Mr. Sullivan opposed the idea of paying wards, and said that tho introduction of class divisions would lead to suspicion on the part of the poorer patients. He hoped the Minister would, stand to his guns and not make any concessions in the way of altering tho systom. The Leader of the National Party (Mr. G. W. Forbes) said that wealthy people could not obtain admission to the hospitals. He had heard it said in some country, districts that it was easier for a rich man to got through the eye of a needle than to get into a public hospital. Before private wards were allowed, more accommodation should be provided in the general wards. He would like to hear what was to be done in regard to maternity hospitals in country districts.

Mr. H. T. Armstrong (Christchurch East) said he did not think it would be desirable to allow the hospital boards to levy rates directly. The boards were supposedt to look after the health of the community, and not to quarrel with people as to what they should pay through the local rates.. He objected to any special treatment being given at general hospitals. The poorest people were entitled to the best treatment, and thero should be no privileged section in the hospitals. Mr. W. E. Parry (Auckland Central) supported tho attitude of the previous Opposition speakers. A DISASTROUS MOVE. Tho Leader of the Opposition (Mr. H. E. Holland) supported a plea by Mr. W. S. Glenn (Rangitikci) in regard to maternity hospitals in country districts. The Government should clearly state its policy in respect to private wards. He complimented the Minister upon tho stand he had recently taken in regard to the question, and asked whether his attitude was tho attitude of the Government. The ward system would in-' troduce class distinction of the worst type. It would be disastrous if the present splendid hospital service was given into tho hands of private practice. A largo majority of the people of the Dominion applauded the recent expressions of opinion by the Minister in the matter.

Mr. P. Fraser (Wellington Central) said that Dr. MaeEaehern came to New Zealand with little knowledge of the conditions in the country. Politically speaking, he was at least fifty years behind the democratic thought of tho people of the Dominion, and he would have been looked upon politically as reactionary sixty years- ago. Ho was not entitled to be taken seriously when he left the subject of hospital administration and entered upon that of the election of the hospital boards. Mr. Fraser referred to the B.M.A. as "this most stringent of trade unions. One of ( the trade unions which manages to con-' trol its members with such an iron hand," and said that the object'of Dr. MaeEaehern's visit would appear to be to get tho system put on a less popular and less democratic basis. "Our hospital system is far and away better than anything that the American continent has," he declared. Government voices: "Hear, hear." "In fact," said the speaker, "I am not sure that there is a hotter system anywhere in the world. It is our sacred trust to see to it that our system is strengthened and widened, that It is enabled to confer still greater benefits upon the people, and that it is not injured in any way whatever." Mr. Fraser went on to refer to the stipendiary system, which, he said, would be welcomed by the hospital superintendents, and probably would come in time. He opposed the paying ward system and the introduction into the hospitals of anything savouring of class distinction. Mr. F. N. Bartram (Grey Lynn) also urged that the present system should be maintained. MINISTER IN REPLY. Replying to the debate, the Minister stated that there was no intention on the part of the Government to interfore with the representative character of hospital administration, although improvements in the system might be made. The hospitals of Now Zealand had an assured system of finance which was tho best in the world. There wa3 nothing to prevent people from giving money to the hospitals, and they often did so. He thanked members for their kind expressions regarding his statements on hospital policy. Whether the doctors referred to by Mr. Savage had modified their views he could not say, but those views followed very closely the official hospital policy of the B.M.A. That policy stated, inter alia, that public hospitals should be so constituted as to be available for treatment for every member of the community, and said that hospitals should be maintained' in three classes: (a) For those patients unable to pay ; (b) those able to pay for maintenance ; and (c) those able to pay for medical attention as well as maintenance. The Minister put on record the hospital policy of the B.M.A. and the opinion of the "New Zealand Medical Journal" that the curso of the hospital system in New Zealand was politics. The hospital boards could please themselves whether or not they had an honorary staff or a stipendiary staff. He would allow the boards the fullest freedom permitted them within the law. As Minister of Health, he had never attacked the honorary staff system in this country, ,but on that point he had been grossly misrepresented by the B.M.A. in that doctor after doctor had come to him and said that he was opposed to the sjstem, "I have: never

been opposed to the honorary system," he added. Both the closed and open systems had their place in New Zealand, and he would not interfere so long as the administration was efficient. He paid a warm tribute to the generosity and humanity of the medical men, but desired to make it clear that the hospitals would be controlled by the people of the country. So far as tho private wards wore concerned, the Minister reviewed the recommendations of Dr. MaeEaehern, whom'he described as a distinguished hospital authority, and said that if the whole subject was looked into it would be found that it would cost an enormous amount if the Government was to provide money for such wards at low rates of interest, as urged iv tho policy of the B.M.A. Losses in fees should be paid not by the sick who could par, but by all sections of the community through the local and general taxes. CLOSER CO-OPERATION. Dr. MaeEaehern's report, he said, contained much which was of value and of use in connection with tho internal organisation of the hoospitals, and with the standardisation of administration. "What we' do want,"/ said Mr. Young, "is closer co-operation between the hospital boards, the medical staffs, and the nursing and other staffs, for the benefit of the patients. I take it that the aim of every one in this country, from the Government down to the humblest citizen, is that our hospital system is not for the medical profession, nor for the benefit of the boards or the taxpayers, but for the benefit of the sick and suffering, so that they may receive the best possible service." Mr. Young said he had no quarrel with tho medical profession, and that he desired their goodwill and co-operation. If every patient paid 15s per day for service in the hospitals there would bo no necessity to make levies for capital or maintenance expenditure. Ho quoted figures from last year's Hospital Report to show that the Government contributions to hospitals exceeded those levied from local rates. As to the country districts, it was the function of the hospital boards to provide maternity services. The Government did not establish homes. The boards wore beginning to realise their functions, in that respect, and also in respect to the uso of preventive medicine, which would save thousands of pounds in the treatment of cases. He hoped every hospital board would recognise its responsibility to the mothers of the country, and that the best possible service within the reach of all members of the community would be given. Regarding the suggestion that hospital boards should levy rates, the Minister said that tho ratepayers now had the right to review the operations of ihe boards at tho time the members were being elected. The ratepayers had the remedy in their own hands if they thought there had been extravagance. If local people would not take an interest in their own affairs, then they only had themselves to blame. The Department had been vigilant in scrutinising estimates for capital expenditure to see that the boards did not go in -for luxuries.

Tho Bill was read a second time, and the House adjourned at 12.15 a.m.