HOSPITALS COMMISSION

Evening Star, Issue 17647, 28 April 1921, Page 9

HOSPITALS COMMISSION

Bccond DAY.—WeDJ.ESDAT, , Tho Hospitals Commission, confirmed its sitting yesterday afternoon. CENTRAL HOSPITALS URGED. Mr Edward Laley, 'member for the North-east Valley Rsnw of theWaotouaifci Ccrantv Council, said his council of opinion-that hospitals should he a charge S n the Consolidated Revenue. Diases of the bodv wore as much a national matter £ Se* of the mind, and his council considered that if the Government admistered ment.l, hospi “<' administer other hospital* 1» teed, thnn! S, “eh island pteGe. Sit frntld ran the h«p,l.ls more ceenomiealh ton at P'f" 1 ' Ivntter follow up the people who did not n y for treatment. Each local °dy i‘m-,1,T -i/lminkter its own charitable aid "Udary. Wherever pjo-n-i-tv was reouired not more than 10 per £$ over the Inst Government valuation b» paid. It was considered that the ■iri'.t syskn, of levies exempted ? mimtr of people from W anything toh the cost of hospital and charitable a'ci

DU FALCONER'S EVIDENCE. Di- Falconer, medical superintendent of tu? HunS K,id .wished c-i v something about the question of distributing the wt of a base Irnl bodies. At present one of bit. hardest s s h s- » &€£ ~f fi, . _v „_i cpT»diuc pntdcnt'3 to ths Ihmrfta Hasp*. l b,m»so tk ' y k ji’ *rLrSl*S- -5 «• ‘ h “ r r HniXti r4«.”‘« WwlTAttfS li om ow« , ev were not tSz Sees of interest to medical stndits He would suggest That they must hnva a direct Government subsidy. Ibe laUents would be charged the ordinary rate of their own hospital, and the overSVitasM mad. up b, a Gmwmmnl rm «* «y means would be bv a special gra Dr Falconer: Acs. - , , The Chairman: It has been suggested that £40,000 or £50,000 bo given to tne four hospitals in the cities. . Dr Falconer: Our board has in addition certain functions undertaken by the hospital which are national apart from p vincial requirements. These are the Medical School, radium treatment, and ■jaw and facial treatment. _ The Chairman: There might bo a deduction from the whole of the subsidies paid to hospital boards throughout New Zealand which could be scattered over the four principal districts towards mamt* nance of the four hospitals. Then the outlying boards would have the right of entrance. ' Dr Falconer; I think that is th. 6 best scheme. It is the scheme favored by my board. The Chairman: What are your views on the establishment of, private wards in public' hospitals? Dr Falconer: I think that has got to coins, hut as far as Dunedin Hospital is concerned we have been unable to apportion a site. I have had very little experience of private wards. Hon. Mr Triggs asked if the system of feeding patients in' hospitals was satisfactory. Dr Falconer said that in 1916 he reported to the board the necessity for a qualified dietist. He thought it was absolutely necessary. A hospital dietist should be trained in connection with the Domestic Science School, using the Dunedin Hospital ns an institution for that purpose. He understood further evidence on this point would be given to the. Commission.

Dr Barnett, speaking in regard to the establishment of private wards in public hospitals, said the Otago Hospital Board expressed approval of the principle. There was a large class of people who, though fairly comfortable, were not sufficiently well-to-do to stand the expense of private * hospital treatment, including the tees of the surgeon or physician in attendance. At the same time,* if these people were allowed private wards in public hospitals, they should not be allowed to obtain their treatment altogether free of professional charges. As the present time maintenance charge was the only charge at the public hospitals. The members of the honorary staff were not allowed to accept any remuneration. Many members of this class of people would prefer to pay a, reduced scale of fee commensurate with their means. Dr Yalintine had laid down a rule that rich and poor alike'were eligible to be admitted to a public hospital. Here the members of the honorary medical staff were quite prepared to submit to this rale provided the rule was generally accepted. But they felt that patients who were in sufficiently good financial circumstances to pay for treatment outside should become private patients in the ordinary sense of * the term. If they were admitted to public hospitals, then they could claim only the services of the paid staff of the hospital, and not the services of the honorary visiting staff, who gave their services gratuitously and with the utmost good-will for the benefit of the sick poor in the district. To carry out the principle of paying wards would entail a large expenditure for building a separate block, for staffing, and for equipment; but, once established, ’he thought a department of this kind would be self-supporting. In reply to Dr Acland, Dr Barnett said it would be simple enough to meet the maintenance charges, which would have to be something over and above the actual cost of the institution. There should be a small margin allowed for bad debts and a margin for interest, etc., so as to make the maintenance part of the wards actually self-supporting, if not profitable. Medical attendance would have to be arranged. The. scale of charges ’as laid down for such operation on attendance would not in most cases reach the maximum. The majority of the patients would be of the class not very well off but not poor, and able to pay a reduced fee. Probably » fee of. say, twenty-five or thirty guineas for some operations would he reduced to fifteen or twenty guineas, as the patient could meet according to his circumstances. To the Hon. Mr Hawke: The patients in private wards would be allowed to call in any doctor to attend them. To the Hon. Mr Triggs: In a private hospital in a large city there would be found practically all the advantages of a large public hospital. There was a good deal of reciprocity between private and public hospitals in the matter of the loan of instruments. The accommodation of private hospitals in Dunedin Was just about enough at present. There was even some difficulty in getting patients into private hospitals on account of the accommodation being taxed. He thought more private hospital accommodation would bo needed here in the future unless private wards were established at the public hospital. Some of the private hospitals specialised in surgical cases, and did not want their beds filled up with medical cases. To Mr Shirtcliffe; There were approximately about 100 beds in private hospitals in Dunedin. He thought fifty beds would be quite enough to start with as private wards in Dunedin Hospital. With reference to financial support for base hospitals, Dr Barnett said that in the interests of efficiency there had been established in New Zealand a series of base hospitals providing, in. addition to the assentials of small hospitals, certain . special facilities for treatment of cases requiring mote-than the ordinafy knowledge, experience, and equipment. Regarding Dunedin Hospital particularly as part of the MedicaT School, Dr Barnett said there bad been a definite and complete statement by the Hon. G. W. Russell that the Dunedin Medical School had * to be the one and only institution of its kind in New. Zealand. There were now

f about 350 or more students at the Medica! School, and in their third, fourth, and ] fifth years of medical study they had to receive clinical instruction at the hospital. •which was absolutely essential to the efficiency of the Medical School, to deal efficiently with largo numbers and to_ cover all the various branches of instruction, a much larger staff of physicians, surgeons, and specialists was appointed to the Dunedin Hosnital than to any other base hospital in New Zealand. Here the members of the visiting staff had to attend tar more frequently and consistently than waa tho case in any other hospital in New Zealand. According to the by-laws of the Otago Board, one of the functions of tho staff was to teach. .One of tho of tho harm staff was to attract patients to the Dunedin Hospital for the purpose of havin'- clinical material for teaching the students. It had been said that the Dunedin Hospital was a small hospital to have connected with a medica > and that the. clinical materia* wasJe-s that it would bo in such a centio of Population as Auckland; but they could get at the Dunedin Hospital as much clinical material as was necessary, P^ ld «“ commodation was available. By tareiui attention to their duties they had <*tahILshcd a good reputation for the hospital, and they ß had patients seeking admission from a very wide district. In many mstances these could not bo taken into the hospital, much as tho staff liked to have them The medical snpenm tendent was forced to refuse admittance to quite a large number of ,. caßes I b ®? a {u® the funds were not at the disppsal of the hoard. This was not in the m.ciests of the Medical School. They had >t the school to train house surgeons for the other hospitals in the Dominion. Ihey bad a bursary system, by which certan students were given certain privileges, that they could have the advantage of seeing all* the cases of importance that came into tho hospital, and they wan e to develop that idea so that the home surgeons of the future and the medical probationers could get aw Me expe i of injuries and disease. Dr Barnett went on to enumerate the’" special departmeu - of tho Dunedin Hospital, particularly dealing with the massage school, tne radium department, etc. The massag school was the only one in the Dominion, and clinical material was required. Tho radium department was tho nucleus or , radium institute for the wnolo Dominion. Money had been raised in Dunedin and Otago, and contributions had come from all over New Zealand, and they had hopes that a radium institute of the utmost value would result. The Government had generously granted a subsidy of 2 the £, and he felt sure that in the near future they would have a supply ot radium sufficient to treat a large "umber of cases. At present they were held up partly by the sup# of radium being insufficient for the number of cases coming forward, and partly because of lack ot accommodation. They required one or two wards set apart for the . treatment ot tho cases. They had had so much cncouraeement from the results of a jyro portion of the cases sent to tho hospital that they felt it would be wrong not to develop ‘the radium department to the highest possible efficiency. Dr Barnett dealt at some length with regardto the necessity of arranging to , hav ® cases housed together, and also stressed tho importance of fracture cases being all combined in a single, department under a particular staff of nurses. In reference to the Medical School Dr Barnett said that additional financial support was required if it was to be developed as they would like. Ho 0 thought seeing it was the only medical school in the Dominion, they should get eyeiy encouragement to expand. They should be privileged to draw patients from all over tho Dominion, and to develop the hospital to a size much larger than the actual population requirements might indicate. Ihey were anxious to investigate matters tha miwht be' for the benefit of the wholo Dominion. He particularly instanced goitre and cancer. . , To the Chairman : Tho subsidy received during last year was approximately £32 000. A further £6,000 (approximately) would meet the requirements of the hospital as. a base hospital, and an additional £6,000 the requirements as a medical school. . , , Dr Nowlands said tho Otago Board had been of opinion for some dears that the treatment of open, active pulmonary tuberculosis should be taken over by the Government. It was not desired to_ escape from any of the financial obligations respecting this disease, and the Govexnftiont could got over that by making a levy on the various districts. There was no ho-pe or eradicating consumption unless its control and treatment were unified under a central system : tho local authorities could not do it. As regards venereal disease, the Government was already doing so much that_ it would no doubt shortly take over this matter entirely. The treatment of this disease was outside the scope of tho local authorities. Provision was also required for cases of incipient insanity? and temporary insanity, for which there was not adequate accommodation at tho Dunedin Hospital. ’ This had long been an open question between the Government and tho heard : but while such provision was necessary it was felt that such an institution should be an outpost of the mental hospital for the district. Speaking of the Medical School. Dr Newlands said ho wanted to make it quite clear that a certain definite proportion of the board’s expenditure was duo to the fact that the hospital was tho practical workshop for the Medical School. That amount was borne by tho ratepayers of the district, whereas it should bo a national expenditure. Mr W. E. S. Knight, chairman of tho Otago Hospital Board, said the value of tho radium in hand was £2,000, and there was £3,000 worth to come. Mr Knight dealt with the provincial subsidies on account of the use of the Dunedin Hospital as a base for smaller districts in Otago, Ho also dealt with the question of international use on account of overseas traffic and the whole shipping of the port of Otago. He asked for maintenance a direct grant of 20 sor cent., which on the present year’s requirements (£75,000) would be £7,500. Tho amount from local authorities would be £33,750, and tho Government subsidy £41,250. With regard to bequests, Mr Knight said that the present limit of £SOO was considered insufficient, and should be increased. Another matter mentioned bv Mr Knight was the relieving of tho board by the Act of 1920 of tho maintenance of'children in tho.andustrial ' schools -. but ho pointed out there were many indigent children in. scum-private religious schools in Otago who had not been committed there, but who were paid for by the board. Tho Act would have the effect, if the matter was viewed from [ the financial standpoint, of the board doI dining to pay for such children, as tho Education Department had to bear_ tho cost, of maintaining all committed Children.

Mr A. F. Quekh, chairman of the Finance Committee of tlio board, indicated that a £ for £ subsidy on capital expenditure was satisfactory to the board. With regard to capital works the board considered that these should be done by loan with a sinking fund to extinguish the debt in, say, twenty-one years. The Government should raise the money in the first instance, application to be made by the boards. With regard to payment for treatment, the board considered that this should bear full relation to the actual cost per bed. -no charge at the Dunedin Hospital used to be 5s per bed, but during the last two years they had raised it to 7s 6d, and that would show a loss on the current year. *■ Tho Chairman instanced thi;ee methods that had been placed before the Commission at various places. One was a uniform charge based on the average cost throughout the Dominion (about £3 per week); second that each board fix its own charge corresponding with the cost of its beds; and third, that a lessor fee than tho average cost he fixed as a uniform fee. Dr'Colquhoun said tho local authorities had two great classes of patients to deal with— (1) Those who were acutely ill and needed constant supervision, and (2) chronic and convalescent cases. He suggested that as nearly one half of the patients belonged to tho latter class they could bo transferred to secondary hospitals in the suburbs with advantage to themselves and benefit to those who had to remain behind. He also put forward a plea for a better method of dealing with cases of suspected insanity, and said that

while ho appreciated what the hospital boards had done already there were many other reforms which could he effected. In his opinion hospitals could bo divided into first-class hospitals (for the largo towns), second-class, and third-class hospitals. Many of those in the second and third categories could be used as secondary hospitals, and in. .regard to the third class ho did not third: that email country hospitals could be too widely scattered throughout the Dominion. ’ ’Hie Commission then adjourned till this morning.