HOSPITAL POLICY

Evening Post, Volume CXII, Issue 95, 19 October 1931, Page 8

HOSPITAL POLICY

SOME MISSTATEMENTS

B.M.A. & BE. yALINTINE

DR, BEGG'S COMMENTS

According to a Press Association message from Eltham, Dr. T. H. A. Valiutine, formerly Director-General of Health, in an address to business men, "expressed opposition to Dr. Begg's scheme for medical men to take control of the hospital boards. He expressed great admiration for the present New Zealand system, which, he said, had been the subject of high commendation from many of the world's prominent authorities." A statement on hospital policy coming from such a source deserves attention. In an interview to-day, Dr. R. Campbell Begg gives a categorical denial to Dr. Valintine's first statement, and makes some striking criticism of certain features of the existing hospital system.

"The charge that the medical profevSsrion is endeavouring to get control of the public hospitals has served from time to time as a political slogan by those who were more concerned with maintaining or securing popularity and votes than with strict adherence to facts," said Dr. B. Campbell Begg. "Those who have used it have suffered considerable discomfiture when asked to withdraw or substantiate their statements. Unfortunately apathy on the part of those who had not the stimulus supplied by aspirations for political honours, or more material rewards has prevented tho charge from being challenged wherever made, so that it is to be feared that it has made aomo headway among those, who have not analysed the various motives behind the statement, and innocently think that assertions at variance with fact would not bo uttered by responsible people, however high, the political value of such, assertions might lJe.

"LACK OF CLEAR THINKING."

"There are undoubtedly some, and among them my old friend, Dr. Valintinc, who sincerely believe that the profession is trying to get control of the hospitals. Other honest doubters are to be found on hospital boards and on other local bodies. The obsession ■which once formed is difficult to remove, arises from lack of clear thinking. Criticism of an existing administration is interpreted as implying a desire on the part of the critics of supplanting that administration, an. error of judgment not altogether inexcusable in those "who are accustomed to think politically. Tliat any individual or group should attempt to reform an existing evil "with no other motive than the public weal is to this class of mind possible In Utopia, but not in the every day world. Challenged to point to any statement or policy which would give colour to their charge, the accusers take Tefugo in, vague allusion to the cloven hoof projecting below tho friar's gown, and at once assume the role of protector of the people against the Satanic forces arrayed against their welfare and liberties. To tne sophisticated they can perhaps ~be> better compared to Don Quixote tilting against windmills.

HOSPITALS AND DOCTORS.

"A common variant of the catch cry is 'Save the hospital from the 8.M.A.,' though why this unfortunate branch of a respectable medical society (some of the critics know that ■ the initials stand for British Medical Association) should be singled out from all others for the special opprobrium-it is difficult to discover. Why not 'beware of the Boyal Society of Medicine, beware of the Boyal College of Surgeons of Australasia, beware of the New Zealand Obstetrical Society.' It is true that the New Zealand of the British Medical Association has more members in this country than the others, though it may be news to a good many to know that a very large number of the bestknown medical men in England are not members. At the same time I think it would be correct to say that all the other societies, and only a few have been mentioned, have taken a fairly active interest in the matters of hospitals and hospital administration.

"J.t is a striking commentary on the interference of politics in New Zealand hospitals that, while in most of the other Dominions and in other countries, medical organisations have takon a more active part than here in suggesting and framing hospital policy, it has been, left for New Zealand to raiso and foster antagonism, betweon the hospital controlling authorities and the medical organisations which should be their most valuable advisers. As far as the Now Zealand branch of the British Medical Association is concerned, ita policy in regard to hospitals as affirmed in 1925, left the control of hospitals entirely in the hands of lay authorities; in. fact, it. proposed no alteration in this tespect.

"My own position was stated as clearly as tho English language is capable of stating anything in an address which was given some prominence in your issue of 28th April of this year. 1 quote the following:—

The proposal leaves the whole power to frame policy in the hands of the board, and the management of the routine affairs of the hospital to a committee appointed from its

members. ... It lessens tho medical control rather than increases it. Personally I am absolutely opposed to medical control of hospitals, and I know in the whole world no hospitals except privately-owned ones that are so controlled.

"A previous suggestion made was that if the two yearly elective system were abolished the control should be in the hands of a limited number with experience in business and finance. It is simply misrepresentation to say that xay scheme or any scheme put forward by any medical man or organisation as far as I am aware advocates that medical men should take control of hospital boards.

"Tho subject would hardly be worth pursuing if it were not for one sinister aspect of it against which it is necessary to put the public on guard. High claims are being constantly made of the general excellence of our hospital system and of the individual units composing it. It is more than doubtful if these claims can be substantiated. Unfortunately the public in general, who can only appreciate external appearances and costs, arc hardly in a position to judge. Tho only body of men who aro in a position to make effective comment with inside knowledge are the members of the medical profession, and the attempt to discredit this form of unanswerable criticism by attributing bias and ulterior motives will have the effect, unless the public is on its guard, of perpetuating certain features of administration which should be subject of the most searching analysis. When you have no case discredit the witnesses is one of the well known methods of defence, but I mistake very much the present temper of the people if they will be content with this method.

VISITORS' POLITENESS,

"The Now Zealand hospital system had been the subject of high commendation from many of the world's most pTomhHsnt authorities," stated. Ba,

Valintino at Eltham. "It is strange how eagor we are to pick up the crumbs of praise which fall usually by request from visitors to this country, but if it is desired to give tho general impression that at all hospital conferences the world over our Now Zealand system holds tho centre of tho fieia as the ideal to be aimed at, I fear disillusionment is in store. Dr. MacEachorn, who haa devoted tho greater part of his time to hospital administration, gavo at tho round table conference on Hospital Policy certain commendatory features of our system. There is a vein of grim humour in certain of tho provisos which were skilfully inserted and are full of significance for the initiated. I quote for example:

1. The policy o£ hospital districts with base and secondary hospitals

. . . which, if properly adhered to as was the original Intention of the Act, would ensure efficiency with economy, etc.

Dr. Valintiue in his speech stated: "The conference adopted my scheme which provided for 20 hospital districts. When, however, the Bill reached Parliament thirty-seven districts had been planned, and consequently my plan was completely upset." (There are now 47 districts.)

2. The principle of a Board- of Trustees as the governing body of tho hospital is sound, provided the members are properly selected and fitted for this work.

3. A central co-ordinating body such as the Health Department is a commendable principle . . . provided it is free from politics. . . .

4. The Dominion hospitals have available (if they want to take advantage of it) a high-class medical profession in every community to assist the honorary medical staff and carry on the clinical work. A few hospitals have recognised this advantage

"FIGHTING BOGIES."

"It will be a bad day for New Zealand if tho medical profession get control of the hospitals," said Dr. Valintine in his speech at Eltham. He may be right. At any rate no one has asked tho profession to take control, and it would certainly refuse if it were asked. Why waste time fighting bogies and imaginary dangers. The existing one is real enough. It will be a bad day for New Zealand if the unjustifiable expenditure of public money on hospitals is not curtailed and if the Government does not take immediate steps to this end. Ido not propose to go into the question of reduplication of hospital services, extrayagance in over-staffing, loose methods of management, excessive length of stay of patients, etc. It may, however, interest the taxpayer who has just been loaded with such heavy additional burdens to know the scale on which medical service is being supplied in some parts of the Dominion. Here are a few instances. One hospital with two beds and an average of 0.8 patients per day, which means that there are no patients at all on frequent occasions, employs a staff of four and costs in maintenance alone £.845 a year. Each patient costs the country over £30 in maintenance alone, and as is well known this is by no means the real expenditure, as certain capita^ and administration charges are not included. This hospital should be closed. The patients could be sent to the not very distant base town, get the best rooms in a private hospital, and medical fees thrown in, and there would still be a considerable credit balance to the hospital board concerned. Another within a few miles of a large town averages 1.5 patients per day, and retains a staff of four. Every patient costs more than £10 per week in maintenance alone. Instances of hospitals which should be closed down at once or reduced to the status of clearing hospitals abound. The tragedy is that under present conditions the Health Department is largely impotent. Medical and administration experts are sent to investigate hospitals, spending a large amount of time and energy sending in a report recommending economies, and the recommendations are rejected at the next meeting of the hospital board. It would be farcical and Gilbertian if the element of tragedy did not predominate. The taxpayers' money is quite unprotected.

"PUTTING AN END TO EVILS."

"It was the.policy of the Government in framing; the Hospitals Act to have no representatives on these hospital boards, although it provides more than half the money. The time of its highly paid technical staff is wasted because the Health Department has no voting power on the boards to see that the recommendations of its experts are given effect to. The Department recommends for example the closing of certain_ expensive and unnecessary hospitals in a given board's area, but it only requires a meeting of local residents and a protest for the hospital to . remain open and continue to eat up the country's money without colour of justification. "I trust that the new Minister of Health will face this problem in a statesmanlike way and on broad lines, Becuring what legislation is necessary to put an end to the evils that at present exist.

"Arbitrary fixing of hospital boards estimates on a reduced scale as has boon done is an. excellent thing in its way, and could safely be carried a good deal further, though it is doubtful how far the Department can enforco its demands on boards who in many instances feel they have an unbounded claim on its money, but no need to accept its advice. It will not do to leave to the boards alono tho methods by which costs can be brought to a reasonable level. If the Department's experts are going to be kept and paid, their services should be used and not wasted in the services of boards who will not carry out their recommendations. Or why keep them at all? Whether the Department should take legislative power to suspend refractory boards or have sufficient voting power through their own Mominees to get their wishes carried out is a matter for consideration. One thing is certain, that if the Health Department in that part of its activities which concerns public hospitals is to be rendered powerless through being controlled by a political head on the one hand, and the dominance r>f unenlightened local control on the other, one vital part of the New Zealand hospital system has obviously broken down. It will require patriotism of a very high order, and the subordination of all political considerations on the part of the Minister, together with the full support of the Cabinet, to put the hospital system on a basis which will enable it to weather the present tempest. A splendid opportunity now presents itself, and tho responsible authorities may feel assured that in bringing about reforms long overdue they will have the full support of tho people who will no longer be hoodwinked by political catch words designed to turn aside criticism which cannot bo met, and support abuses which cannot be justified."