THE LAST WITNESS

Evening Post, Volume CXXV, Issue 116, 19 May 1938, Page 10

THE LAST WITNESS

HOSPITAL INQUIRY

SIR J. ELLIOTT'S OPINIONS

COMMUNITY SYSTEM

The last witness to be heard by the Hospital Commission was Sir James Elliott, who, at the invitation of the Commission, gave his personal opinions of the needs of the Wellington hospital district at yesterday afternoon's sitting. Sir James expressed the view that the Wellington Hospital was misused in that,, while fulfilling its proper function as a metropolitan institution, it was being put in the position of a reception house for all cases of sickness. He strongly supported the community hospital system,

The personnel of the Commission is as follows:—Mr. A. H. Young, of Christchurch, principal Stipendiary Magistrate, chairman; Mr. D. S. Wylie, C.M.G., C.8.E., of Palmerston North, medical practitioner; Dr. H. HardwickSmith, of Wellington, medical practitioner. Mr. A. E. Currie is appearing for the Crown, Mr. J. O'Slfea (City Solicitor) for the City Council and other contributory bodies, and Mr. G. R. Powles for the Wellington Hospital Board. Sir James said that he was an orary consulting surgeon of the hospital, but was not now on the active list. Probably the best line of approach was to consider what was the proper function of a metropolitan or base hospital. There were patients in the Wellington Hospital who would not be admitted to any first-rate hospital in England or America. They would go into a much cheaper hospital, where they would get treatment just as good in relation to their disability as in the best hospital. If certain of the older parts of the present hospital were set aside for such cases it would be satisfactory as a temporary expedient, although the older parts of the hospital were unsuitable when they were built; .They would fill a useful gap for sub-acute and chronic cases. He thought it was desirable that; all hospitals should be centralised in the area belonging tp the Wellington Hospital. FIRST CONSIDERATIONS. What he would be impressed with would be a really first-raje base or metropolitan hospital of 500 beds or so with every facility, and another institution that would look after all the tremendous amount of sickness in Wellington, Sir, James continued. In his time he had sent thousands of patients into the Wellington Hospital who should not have been sent there if there had been any other place for them. They had stayed there to the detriment and delay of other more pressing cases. It wps the usual prac-! tice to provide institutions for chronic cases and convalescent-patients within a reasonable distance of the central controlling hospital.

For a reasonable solution of the problem the primary thing would be to have a proper acute hospital. The Wellington Hospital was overdue for overhaul as accommodation. He thought 250 beds should be provided for. a start /in a new building, with a complete new hospital providing up to 500 beds visualised and nothing done in a haphazard way. He saw no reason why the children's hospital should not be left alone in the meantime; and the Feyer Hospital and the Ewart Hospital were all right. The old building would do for overflow, sub-acute, and chronic cases. He would not take the view with, regard to the proposed new block that money was a secondary consideration, that the best must be provided. The architectural aspect was important but subsidiary.' It was the treatment and facilities and skill that counted. He would have a job done as cheaply as possible, so as to have it durable, airy, and roomy, and with all proper facilities. He would not have a monumental, massive building. There was no reason why there should not be a cheap hospital at the Hutt with 100 beds to relieve the pressure on the main hospital. It would be a sad state of affairs if- a second hospital as he visualised it could not be built for £1000 a bed, and that would be liberal. - -

There were plenty of handy sites that could be used! for convalescent and chronic cases, said Sir James. Later on, when it was feasible, there should be a children's hospital somewhere near the beaches for other than acute cases. There were many patients who should not be occupying £2000 beds at the hospital. The percentage qf cases in hospital in general in New Zealand far exceeded the experience in other countries. HOME NURSING. No serious consideration had ever been given to the question of nursing people in their own homes. Much could be done with a proper district nursing scheme. A great many of the people who went into hospital could be nursed in their own homes. Many people would prefer that course. There was a tremendous number of people living in rooms, and he thought they were waiting for the State to provide for them. For such cases as he had mentioned the old hospital could be used temporarily. while some other place was being built. His own view was that the type of hospital pictured by Mr. Stephenson would be wasteful and. unnecessary.

In .reply to Mr. Powles, Sir Jamas said he was afraid there was a greater tendency in New Zealand for people to rush into hospital than there was in other countries. In London, for instance, an operation case doing well in a fortnight or sixteen days was sent in an ambulance to another institution under the same control. FINANCIAL BURDEN. Speaking as a ratepayer* Sir James said he thought the whole thing would break down financially if they went ahead at the speed urged by some enthusiasts. Unless there was a community service or the State took over a stage would be reached \Vhen the bank of the ratepayers would be broken.

In reply to Mr. Wylie, Sir James said he would stress the growing importance of providing 1 intermediate and paying beds." He had been interested in the subject all his professional life and had seen the community hospital system in other countries. He thought "that people who condemned the community hospital had never seen one and knew nothing about it. The London hospitals werepractically all going in for paying beds, because they could not manage financially otherwise. He had never seen any friction caused by it. Apparently New Zealand did not want to do what was being done in other countries, but he thought it might be started in a small way. If it did not work it could be given up. The system was in operation in certain parts of New Zealand now, but it was not well known. "WANT OF KNOWLEDGE." Mr. Wylie: You have heard it said that the introduction of the community hospital would mean differentiation of treatment?—l think that if based

on want of knowledge. People can, say what they like; it all depends on whether they have gone into the thing and have had experience of it.

To. Dr. Hardwick-Smith, Sir James said they had to treat the Wellington Hospital according to its rightful status and not make it do all kinds of work for which it was too costly ap institution and for which it should not be required. After the provision of a good acute hospital there should be a hospital in the Hutt Valley.

In reply to the chairman, Sir James said that the home nursing system had never been pp-operly co-ordinated. The various activities should be brought under a central controlling body. Up to the present they had only touched the fringe of home nursing, which could do much to cut off at the source the trend towards over-hospitalisation of the community. Much of the hospitalisation was due to insanitary rooms, want of exercise and a free life, and a foolish dietary.