REPORT OF THE SELECT COMMITTEE ON THE, HOSPITAL MANAGEMENT.

Nelson Evening Mail, Volume VI, Issue 122, 25 May 1871, Page 4

REPORT OF THE SELECT COMMITTEE ON THE, HOSPITAL MANAGEMENT.

Q The Select Committee appointed to enquire into and report upon the best means of managiug the Nelson Hospital, beg to report as follows : — It will be seen by reference to the Report of the Select Committee of the Council, dated May 1868, that on the removal of the patients of the Nelson ; Hospital from the small and inconvenient building then in use, to the present commodious structure, a complete remodelling of the Hospital Staff was deemed necessary. Especially, the chief medical care and supervision of the Hospital was transferred from the private medical practitioners of the City, to a surgeon residing in the Hospital, and devoting himself solely and entirely to his public medical duties; duties including, besides the care of the patients within the Hospital itself, that of :. the numerous out-patients, of the inmates of the Taranaki Buildings, of the Gaol, of the Lunatic Asylum, and the Police*. A consulting physician was also provided for by the Council, and subsequently appointed by the Hospital Committee. The carrying out these arrangements has, it is commonly believed, been needlessly costly to the public, and has also been the source of some dissatisfaction to the medical profession in Nelson. Your Committee, in- conducting- the enquiry entrusted to them, Have directed J their attention carefully to the practicability of effecting a more economical administration of the Hospital, and of removing the existing dissatisfaction of medical men in relation thereto. With this view your Committee sought the advice of all the medical profession within reach (whether in or out of practice) and have received the readiest 4 and most courteous assistance ! from eight of the gentlemen whose evidence they invited.. Your Committee find that there exists great diversity of opinion among professional men themselves as to the proper medical management of the Hospital, and the following modes were among those suggested — . rjs)' Placjn^the Hospital patients in of the medical practitioners of the City in rotation, having in residence a skilled wardsman, or a young mat) without full medical qualification acting as dispenser of medicine. (2.) Entrusting the chief medical charge and responsibility to the medical men in private practice (or to such as chose to accept a share of the duties) having under .them, as resident surgeon, a young professional man just entering practice. . ; (3.) Engaging as resideut surgeon in sole charge a skilled and experienced practitioner at a sufficient salary to secure his permanence. Your Committee have good reason ,to believe'that the charge of the Hospital in connection with the several duties befqre enumerated would make far too large demands on the time of any medical man j in full practice, and would not be accepted by such. ! The second mode : your Committee cannot but regard as both costly and unworkable, and besides, objectionable, by necessitating frequent changes in the resident surgeon. j Your Committee have, after long apcL. earnest consideration, come to the conclusion to recommend the adoption of the third suggestion — ' (1.) Because they believe that it would be less costly, and more efficient than' any plan which left the medical administration in several Bands. ' ' ' ; ' ; (2.) Because it would avoid the evils and,: discord inevitably attendant on any attempt, at subordination in the medical officers of ! thef Hospital'; . : " i>j "' !;! i "■■-':■''•';■'• ; (3.) Because it would rempve whatjis., beljeyedto be. ,tljie chief dissatis^ faction of the medical profession, 1 viz, the repeated ipt!;od#esiqii of, new practitioners' thrpug%the Hospital, each in r fmju having (as is alleged) -peculiar advantages for.', paying tUe^QUodatiQtt lAftft future private practice to^which the j shortness of the en-

gagpmeot presents no obstacle, and the .smttllness of the salary offers au inducement. ' "THere need thus .be but one salaried medical officer a»tach>(l 10 il»f Hospital, «& any other (which neednoJ. Ur, (r?-.< quent) rasjr lie obtained by,>the' Xl^-idHrit;^ Surgeon us occasion may retire and be met, by fees. v . The carrying out this plan might be found to necessitate the admission of a, married resident surgeon. -.'■:, - J Although giving the Committee of Management credit for a desire to make the most of the funda intrusted to them, your Commiitee hope that a reduction of expenditure may be effected. (1) By a more rigid exclusion from the benefit of the Hospital Funds of those patients whose circumstances , do. not entitle them to become recipients of public charity. ' «~ (2) By a strict adherence to the dipta^y scale laid down by the Mauaging Committee. (3) By a less lavish use of medical com- , forts. Your Committee are aware of the great difficulty attending the enforcement of these views. If. is neither practicable nor desirable to confine the use of the Hospital to those abnolutely destitute, and (lie Managing Committee must often fii d it. difficult to determine (<S{ eH^Hy fr) the f»ce of delilierute atiempis at deception) to what extent the circumstances of a patifnt- entitle him to relief. \ Public morality in such chsps is ofVn at fauh,. and\a becoming pride an I heal'liy spir i t of independence are too often wanting. In many instances, too, t.hn relatives of the sufferers might, by the exercise of a Ifrtle self- sacrifice, have prevented any. app/itoatiou for public relief. In order to prevent or discourage what yonr Commirtee mu,st call a misapplication of charitable funds, it has been suggested f at persons should not, as a general rule, receive ■ Hospital aid (except in case of accidents or other emergency) without a certificate from the Relieving Officer. . A strict application of sucharule would, do doubt, (especially in the case o? out patient.-), tend greatly to reduce the demand on the Hospital funds. ; Your Committee would also recommend .that the Hospital. Management Committre should he increased from three to five, one ;of the new members being chosen by the Superintendent and the other by tl>e Provincial Council, theenlnrged Committee having thus two of its members nominated by the Superintendent and the remain in x three by the Provincial Council. This recommendation is made on the belief that a resolution of the Council to that effe«t might answer every purpose till the next session, wh.n a Bill should be introduced to give more permanent effect to ihe proposal." j Your Committee cannot- conclude this Report 'vitbbut disavowing a^is intention in such suggestions as they may have made of throwing reflection on the Hospital Management Committee, who,'?, they believe, have been actuated by no other j desire than that of rendering the Institution in their charge as efficient as possible for the purposes for which it was [ erected. " .'..., )&-In order .that the new Committee of management may be unfettered iv miking such arrangements as they may deem fit,, your Committee do not think it advisable to make any recommendation's with respect to the number or salaries , of the Hoap'ital staff, desiring to ieave all( such details to the said Cpmmittee, with winch view your Committee recomrnenjl that-. the Vaiira of £2500 be placed on the" Estimates and? be at .the' disposal . of , %Ue t mauagihg bbdy, to meet every expense in coViuectiou with the Hospital. ' (Signed) Henry Alex. Tarrant, l[ ' 1 ;■.:■• Chairman.