National Health Service For Northland

Northern Advocate, 25 September 1943, Page 5

National Health Service For Northland

Doctors Alice Bush, Howard Gaudin, J. McMurray Cole, Selwyn Morris, E. F. Fowler, Bruce Mackenzie, Elizabeth Hughes and Douglas Robb, of Auckland, have published in book form the result of their studies, aimed at the creation of a national health service for New Zealand. In an appendix is set out a unified plan of medical services in the Northland peninsula. The proposals are as follows: General Plan The idea is to see what kind of service for the residents of Northland might be provided if the resources at present devoted to the maintenance of the existing hospitals, and those used for paying for general medical service under Social Security, were pooled, and a co-ordinated scheme put into operation. The present hospitals at Kaitaia, Whangaroa (or Kaeo), Rawene, Dargaville (moved from Te Kopuru), Kawakawa (Bay of Islands), and Whangarei would remain. The first five would continue to do a certain amount of general medical and surgical work, though the more difficult cases would be moved to the base hospital at - Whangarei. Casualty work and maternity wards would continue as at present. In general, the five hospitals would be slow to develop costly equipment, and part of their present buildings might be adapted to house the consulting rooms of the local doctors and the district nurses.

The local medical centre's could, and probably should, all be housed in the existing hospital buildings or grounds. AJ! calls" for help would go to the centre thus set up at the hospital. Urgent and serious surgical cases could be admitted to local hospitals and be ;*2on promptly when necessary by the appropriate specialist from Whangarei, with or without his mobile team and equipment; but in general, major surgical work would be carried out in Whangarei. The medical side might be maintained more fully in the local hospitals through weekly visits by the physician or other specialist. The Whangarei Hospital, on the other band, would have increased duties, over and above its present services to its own district. In it would be based the specialists, and to it would be brought the more difficult and complicated cases from the other five centres.

The scope of work to be done in Whangarei Hospital and in the rural hospitals would have to be considered and specifically laid down, in the light of contemporary medical staff’s interests and capabilities. ' For example, all cases beyond minor conditions might be sent to Whangarei from Whangaroa, whereas Kawakawa and Dargaville might retain locally some major surgical and medical conditions (whether treated by local men or by the specialist cn one of his visits). Similarly, a schedule of cases to be sent to Auckland would be set up, and altered from time to time after consultation between the staffs of the hospitals at Auckland and Whangarei. The Whangarei Town Centre, likewise, would have an additional duty. Not only would it house the general practitioners of the borough and county, and their assistants, but it would also act as the Northland Polyclinic, and house the Outpatient and Follow-up Services of the specialists. In this latter respect ii would serve not only Whangarei, but the whole Northland.

The situation of the Whangarei Centre might well be in the main street of the town, the hospital grounds being one and a-half miles from the post office, and fairly crowded already. Cn ihe other hand, if a suitable site could not be found there, and the centre had to be built near the hospital, cr on the road out to it, additional transport facilities would probably grow up, and a astisfactory result be achieved. The radiologist and the pathologist would require space at both hospital and centre. It is a small matter at which their main base is situated. The same can be said of the two social doctors or public health officers. Medical Staff Required

General Practitioners (Men). —Whangarei (centre only), 5; Hikurangi, 1; Waipu, 1; Dargaville (hospital and centre), 3: Ruawai, 1; Paparoa (maternity hospital), 1; Kawakawa (hospital and centre). 3; Kaikolie (maternity hospital), 1: Rawene (hospital and centre), 2; Kohukohu, 1; Whangaroa or Kaeo (small hospital). 1; Kaitaia (hospital and centre). 3; total, 23, or 1 per 3000. . . Specialist Staff at Whangarei.— Physician specialist, 1; surgeon specialist, 1; orthopaedic surgeon specialist, 1; obstetrician and gynaecologist, 1; children’s specialist. 1; radiologist. 1: pathologist, 1; eye, car, nose and throat surgeon. 1; senior resident or registrar (hospital), 1; junior residents (hospital), 2; public health officers, 2; total medical men in region, 3ti —1 per 1888. Oilier Details

Tire hospital at Whangarei would probably need to be enlarged to 150 beds excluding maternity, ancl to have improved surgical and. specialist facilities. All members of the stall except the residents would serve part-time at the hospital, part-time at the polyclinic (incorporated in (he centre), and part-time visiting the rural hospitals and centres. While the general practitioners in Whangarei would work most of their time in their own centre and at their visiting, assistantships to the specialists in centre and hospital should be arranged where possible. The Centre in Whangarei would house five consulting rooms and waiting rooms for general practitioners; five consulting rooms and waiting rooms for specialists; casualty room and minor surgical theatre; district’ nurses’ headquarters; infant welfare and school children survey base; library and reading rooms; rooms for medical' and public meetings; accommodation for X-ray, laboratory and public health offices in relation to that decided on at the hospital. Cost The features in this scheme representing new expenses are:— (1) Increase in buildings at Y.mangarei Hospital. . . , . (2) Medical centre and polyclinic building in Whangarei. . (3) Specialist staff at Whangarei to serve whole area. Buildings.—-Little or no now building or equipment would be needed in the five smaller centres. Whangarei Hospital: To add 50 beds, and establish full X-ray and pathological departments might cost £50,000. Medical centre and polyclinic, estimated at £25,000. Specialist Staff—Already existing is one medical superintendent, one assistant medical superintendent, and one public health officer. That leaves ten new ones, the cost per annum, at an average of £1250 per annum, being £12,500. General Practitioners—Existing general practitionex's are maintained out cf Social Security funds, presumably largely on the 7/6 scheme. The total cost is not known to us, but supposing the income under this head be taken at 15/- per annum per head of population, the sum of £51.13a per annum is available. To this should be added a sum, amount unknown, which is now paid out in 7/6 rebates cn specialist fees paid by Northlanders for private specialist consultations, often in Auckland —say £SOOO, the total then being £56.135. Pay each general practitioner an average of £1250 per annum, total being £28.750. Add to this £12,500 for the ten new specialists. There still remains £14,885 per annum with which to provide extra nurses for district work, technicians for X-ray and laboratory, cost of upkeep of centres, library costs, and sinking fund expenses towards post-graduate study leave for doctors and nurses—without expense beyond present limits. Note on Salaries. —It is obviously unwise to mention figures at this stage, detailed conditions of the service being undetermined, some even unimagined; £1250 is taken as an average between say £6OO- - for a junior home doctor or senior resident, and £ISOO-£1750 for a senior specialist. These salaries should be clear except perhaps for a contribution to superannuation. The figures taken are therefore used for purposes of calculation only, and no further significance should be given to them. Summary At first sight it seems incredible that such a vastly improved service can be imagined at 'a cost perhaps no greater than is being paid out at present—certainly not much greater. ‘

‘ The secret is in the planning or organisation for specialisation of function ami for co-ordinating the work of practitioners and hospitals This co-ordination is very loosely earned out now. Moreover, the system of payment of general practitioners bv the 7/6 scheme is probably wasteful, though the figures are not publicly known. Under the conditions proposed, the doctors should bo almost as well eff financially, and much better ofl as far as conditions of life and work go. The people should receive a very much bettor service in all respects than they do now.