THE B.M.A.

Nelson Evening Mail, Volume LXIV, 4 February 1930, Page 6

THE B.M.A.

AND HOSPITAL POLICY

ATTITUDE 01 NELSON BRANCH

The following circular'has been addressed to the medical profession of New Zealand by the Nelson branch of the British Medical Association:—

The Council of the New Zealand Branch of the 8.M.A., after consultation with the divisions, has decided to re-open discussion on hospital policy de novo at the annual conference at Christchurch in February.

The Nelson Division, having always felt that the policy to which the Branch has been committed for the last six years is on mistaken lines, desires once more to place its views before the profession in (lie. hope that fuller consideration and freer discussion may result therefrom at the Conference.

Brieflyj the position is that at three annual 'meetings the N.Z. Branch has enunciated its policy as the adoption by our State hospitals of tho American community hospital system. That is to say, the State should undertake the responsibility of providing all buildings, equipment and facilities for the treatment of the sick of the Dominion who required hospital attention, the type of accommodation and the charges therefor being graded according to the means of the patient. Medical services would be honorary in tho case of those unable to pay, and privately arranged by those able to pay. It is not quite; clear, under the policy, who should be responsible for the staffing; but it cannot be doubted that eventually those who paid the piper would call the tune.

In 1926 the only conceivable condition under which the policy might work was added, namely, that the system should not be adopted until the hospitals were placed under a non-political board of control ; but in the meantime nothing has been done to bring about that essential condition, and there are now evidences of a tendency on the part of some divisions even to disregard it. During the six years that have elapsed since tlu> adoption of the policy it has made no advance in public favour; there has not been the slightest indication on the part of any responsible body of a _ real desire to adopt it; and the position of the profession in relation to the hospitals has steadily deteriorated.

'fhe Nelson Division does not question the advantages of the community hospital on a voluntary basis, but maintains that it cannot he grafted satisfactorily on our existing system under state control for the following grave and fundamental reasons, and for others too numerous to detail in this circular:— 1. It is impossible—(a) Because the public are emphatically against it. The man in the street, the boards, the Department, the politicians, one and all regard the scheme, as impracticable, costly, and essentially a plan of the profession devised for its own purposes, especially to procure at the public expense facilities for its own private work and profit. Six years of discussion have not modified this attitude in the least. (h) Because it is economically impracticable. Tho State will not, and probably cannot, undertake the capital expenditure necessary to initiate the scheme. The Director-General has repeatedly indicated this, and with good grounds. The hospital expenditure of the Slate is already so excessive and extravagant that it has been giving concern for years, and the policy would greatly add to it. 2. If the policy were possible it would be unsound—(a) Because the absorption of the State's energies in such an expensive system of treatment of disease would further divert it from its alreadystarved, true, primary function —the prevention of disease. The funds which, under the policy, the State would be lavishing on the personal win fort of individual well-to-do sick ought to he applied to the control of disease for all. (h) Because it must inevitably re- ( suit in the complete subjection of the profession to a Government department with the concomitant evils inseparable from arbitary beaurocratic control. (c) Because the classification of patients essential to the scheme, while practicable in a voluntary institution, would be impracticable in the State Hospitals. The people will not admit any classification in their own hospitals excepting that imposed by the requirements of illness; but if they did, the costs of State Hospitals are already so high that the fees charged to paying patients in order to cover all expenses in regard to their own accommodation and provide something to reduce the loss on the nonpaying beds, as per community scheme would have to range np to ton or twelve guineas per week. Patients, however wealthy, would certainly resent paying such high fees, when sick, to an institution they had been compelled to provide for themselves when tliev were well, and in addition hav-

ing'to pay their private medical attendant. The classification system as an effective instrument would thus be doomed to break down. The profession having no controlling voice, and with its private enterprises throttled, would eventually find the hospitals run solely by stipendiary staffs, and the deficit "on all classes being made up at the cost of the State.

It is indeed fortunate that the Association has not succeeded in inducing the State to slip this noose around the necks of the profession and of public health.

This Division urges that the true economic and scientific policy is that the State should increase its energies for the prevention and control of disease, rather than for the treatment thereof; that in regard to hospitals the State's duty does not extend beyond the necessary provision for infectious diseases and indigent sick, which should be free, and for which the profession should provide honorary medical service wherever required j and that for other classes provision should bo developed by private enterprise and voluntary effort, which is quite possible by more combined, more self-reliant, 'and more energetic action of the profession itself. The public and voluntary hospitals can easily work together. The public laboratories have to be maintained in any case, and their services should continue available for private work where necessary : and when it may he necessary or desirable that public hospital facilities should be used for oilier than indigent patients, we see no reason whj these should not be available to anyone provided payment to cover the whole cost be made, as laid down by the Page Commission.

The policy we advocate above, unlike the community hospital proposal, will not arouse very serious opposition. The principle of honorary staffs is obviously in the interests of the whole public. The poorer majority will have no object in opposing it. The Government, the local bodies, and the saner members of the public will accept with relief a proposal which will call a halt to increasing hospital expenditure, and removal of the class distinction stigma will appease labour circles. The time is ripe and opportune for the development of a policy which releases the State for its proper health duty, provides adequate service for the people, and preserves for the profession control of its own affairs. In conclusion we might point out that

the members of this Division have in/ personal ends in view, but are concerned as to the coining generation of practitioners and the future of the profession rather than their own immediate position. We would remind members also that, though the Association has rarely exerted its power, and in the past has made only an ineffective showing in hospital questions, it can, if it chooses, carry into effect, any practicable policy ou which it is unanimous. The policy outlined above we believe to be in Hie best interests of both Stale and profession, and, involving no serious reversal of custom, can readily be adopted, and would put an end to the drift o( hospital matters.