HOSPITAL REFORM

Grey River Argus, 20 February 1932, Page 3

HOSPITAL REFORM

DR. BEGG’S SCHEME Some Particulars Writing for the “Post’’, Dr R. Campbell Begg outlines a hospital reform schema as follows: Forty-five hospital districts and forty-five hospital boat ds ex’st to-day. Nine of these boards serve small populations of from 2000 to 0000 people. Fifteen of them have less than 10,000 people in their districts. These fifteen boards look after a total of 81.000 people (1930 statistics). On the hospital bed basis per thousand laid down by the Conference of Rural Hygiene held last year under the auspices of the League of Nations, namely, two par thousand, the number of beds required for this population is 162. The minimum number of hospital board members permitted by the Act is eight, so that it re. quires at least 120 board members to look after this population of 81,000 people, almost one member per bed on the Geneva Conference scale. How little standardised hospital service is may be illustrated by comparing one hospital district with a population of about 5000 (1930 figures), two small hospitals with a total number of 24 beds and an average of 11.5 patients (fewer than many small private hospitals looked after by a nurse), whose chair-

man draws an honorarium of £lOO a year, and another hospital district with a large area, a population of well over 100.000 or as many as seventeen other boards’ areas put together, five institutions, and nearly 400 beds where the chairman draws the same honorarium of £lOO. In only thirteen of these hospital boards’ districts does there exist a centre of population of 12,000 or over, which is considered the minimum for the conduct of an efficient Class A base hospital. In many, the largest centre is a town; hip of a few hundred people with one resident doctor for this and the surrounding district. No patient can be transfered from one of these districts to a more fortunate one with a base hospital without a- good deal of formality, including a guarantee to the latter that the full charge for maintenance will be paid, even although the smaller board may itself recover nothing from the patient. The practical inability of residents of the smaller districts to enter base hospitals, that is, to receive efficient diagnosis and treatment in chronic and many acute conditions* is recogni.s n d and deprecated by ’the Department of Health, which administers the hospitals. To quote from the appendix to the annual report of 1927, page 6 (the comments in brackets are mine): “To convert into a thoroughly equipped modern

hospital, at least one nstitu' ion in each of the 47 districts (the number has been ■ educed to 45 since then) would cost more than the Dominion could afford or would indeed be warranted, (it would also be impossible with the medical resources available.) The ten-, dency therefore is for pat-cuts of the! smaller districts to enter the . . . I base hosp tals of their neighbouring d strict which results in innumerable (1 spates between the boards concerned. . . . This fee (payable for maintenance by the smaller to the larger board) in no case represents the actual full cost of treatment. The board receiving th.-? account, however, resents the patient not having availed h mself of the ho: pital facilities in his own district.’’! Nothing could more clearly shew that • electors of small districts are disfranchised, as it were, from lece'vng efficient base hospital treatment. It is proposed to reduce the hospital board districts to eighteen, of which thirteen would contain within their bounds a Class A hospital, while five wou’d have to be content with a Class B base hospital. To complete the scheme, the additional proposal is made that four metropolitan areas be constituted, based on the four main cities of the Donrnion. These woud be at the disposal of the bare hospitals to fill in the gaps which would arise in regard to facilities for certain forms of diagnosis and treatment, more especially felt by the Class B hospitals. Each of these hospital d : stricts would then be able to provide an effective decentralised administration of its own with cottage hospitals and district hospitals for the treatment of simple eases| and acting as feeders to the base hos- j pitals were more difficult case? were concerned. They would be able to maintain strategically p'aced district nurses with a bed or two for urgent case pending transport to the base. They could place ambulances at t uitable points, drivers to be arranged **or from local police or fire brigade officials, or by private garages, under arrangement. Proper lines of communication by telephone, telegraph, or wireless would ensure the complete linking up of the inhabitants with the ambulance sta. t’ons and hospitals. All this work could I be done much more effectively by strong boards in charge of large districts than by a central administration at Wellington hampered by the attempt to co-ordinate the activit’es of numerous small boards operating in the same area. The main object would, of course be to land all cases with the utmost rapidity at the base hospital, at the fame time seeing that prompt he’p was yvailab'e on the spot. SPght eases would be treated at outlying stations and the cost of transport and the inconvenience to the patient avoided. The advantages of this arrangement from every point of view are s o numerous and so obvious that »t is amazing that the existing conditions have been allowed to continue. Some of the most important are as follows:— (1) Better Hospital Boards.—Of the 40 or 50 board members now control-

ling a series of small districts, only eight to twelve of the most experienced would be on the new board. (2) Better superintendence.—Only 18 good supei intendants required instead of forty-five. These could be well pa : d and supervise and co-ordin-ate in one group all the district and cottage hospitals, communications and transport facilities, as well as the base hospitals. Administration would thus be kept free from actual medical wo f k. (3) House Surgeons and Junior Medical Staff. Sufficient would be available. They would only be used at base hospitals. (4) Hospital Association. This body reconstituted to give equal representation to the administrative and medical side would become a valuable organisation to standardise staffing and supplies. (5) Improvement of Nurses’ Training Schools.—The Class A base hospitals would be the centres for nursing education. There are many unsuitable nurses’ training schools among the 33 at present existing. The quality and supply of trained nurses would be better -egu’.ated. (6) Facilities for Research and Progress. —The system of metropolitan hospitals closely linked to a group of base hospitals would put New Zealand on an equal basis in these respects with countries with larger and more concentrated populations. The reform is overdue. The people of the Dominion should see that it is no longer delayed.