HOSPITAL CRISIS

New Zealand Herald, Volume LXXII, Issue 22046, 28 February 1935, Page 12

HOSPITAL CRISIS

[POSITION IN AUCKLAND FAULTY ADMINISTRATION SHORTCOMINGS OF THE BOARD • THE ELECTION KiXl MAY No. I. In a little over two months' time tho electors of Auckland will be called upon to decide who shall fill a majority of the seats on the Auckland Hospital Board for the next three years. In other words, the public is being asked to choose a body of citizens .to conduct the largest hospital in the Dominion, an institution which in recent years has grown inordinately and which is rapidly approaching a crisis in its development. It is not at all to the credit of Auckland that its people have long shown an extraordinary want of interest in the selection of a body to carry . out jfchis most important public duty and also to administer charitable relief. .Whenever election-time comes round, the Hospital Board is always the " Cinderella " among the local bodies concerned. There is a dearth, not only in ,the number of candidates but also, it must be said, in candidates having the qualities most needed for hospital administration. Apart from vacancies caused by death and retirement, there has been little change in the personnel of the board for a long time. The,same may be said of some other Auckland public bodies, and the fact would not be important „if it could be stated with truth that the Hospital Board's affairs were in a thoroughly satisfactory state and that the board as a body was thoroughly ,well fitted for its task. Unfortunately there are many reasons for saying that the management of the hospital badly needs an overhaul and that this cannot be effected unless sufficient new members of the right type are placed upon the hoard. Fall in Efficiency The Auckland Hospital, with its 750 beds, is one of the largest in the Empire. It has, in fact, grown beyond the size which is regarded as normal or efficient in British countries. A body of medical opinion in Auckland is emphatic that its efficiency has fallen below that of good hospitals overseas. Even if that were not so, the continued rapid growth should give cause for uneasiness. The present board makes but slow and ill-directed efforts to meet the crisis. So far as the public can ascei-tain, it has no defined long-range policy for the hospital's future, nor has it "had one at any time since the close "of th'e Great War. Members of the public, medical and lay, who take an interest in the affairs of the'institution, hare come to the conclusion that in tMs matter nothing can be hoped for ixom the board as at present constituted. t Out-of-Date Legislation It is no answer to say that the faults pi the Auckland board are shared by other hospital boards throughout the Dominion, or that the public "hospital legislation is basically faulty," and many years out of jdate. No sweeping reform in the law can be expected in time to meet the approaching crisis in the Auokland Hospital's affairs. All tho more reason, then, why the best board obtainable should be elected to deal .with, the situation. One of the fundamental difficulties is that a single board is called upon to conduct- the hospital and also to administer poor-relief. This is a relic of more than 50 years ago, when hospitals existed almost wholly for the sick poor, when anaesthetics, and antiseptics were novelties, and abdominal • surgery, or major surgery of any kind, was practised only as a last resort. Today hospital treatment is needed at somis time or another in life by almost a majority of the' community, and the greater number of those who require it make use of the public hospitals, where they pay .considerably less than the cost of '.the service rendered. This is true even when a patient meets his account in full. Very often he pays only part of the bill or nothing at all. The payment of hospital rates, directly or indirectly, is' regarded as a kind of medical insurance, whereas it was originally a contribution to the needs of the sick poor. Drawback of Dual Function JLn this way a socialised medical service has grown up, based, so far as the larger, public hospitals are concerned, | mainly upon the work performed free of charge by scores of honorary surgeons and physicians. These professional men wish to serve the public and they value the experience and'prestige which honorary hospital work gives them, but they cannot help realising that such work is becoming more and more against their own pecuniary interests as private practitioners. It is quite evident that such a system bannot continue indefinitely. The scope of the public hospitals will certainly not be narrowed, since they provide special services and equipment —such as X-ray plants, radium and pathological laboratories—which must be centralised. Possibly the financial solution will be provided some day by a national scheme of contributory health insurance. In the meantime, the dual function tof hospital, boards tends to confuse both administration and policy. As distributors of relief, boards are very apt to put quantity before quality in hospital work, and to become lax in tho collection of hospital fees. Their personnel, moreover, tends to represent more aud more those sections of the community 'which expect to obtain benefits in the form of relief or practically free hospital treatment at tho taxpayers' expense. This tendency, combined with lack of interest on tho part' of otjier classes of electors, deprives the boards of the services of business and professional men, whose help is absolutely indispensable to the efficient control of the public hospitals. Need fox More Capable Members The inference from all this. is that jwtiile the present unsatisfactory machinery of hospital administration remains it can be operated to tho best advantage/ only bv boards as well equipped as, possible by general education and by business or professional training and-experience, for co-operu-tion with" medical men in the difficult task of managing large and complex institutions. in a time of progress and change. After every acknowledgment is made to the present Auckland Hospital Board, its membership on the average does not measure up to this standard. > The relations between the beard. and the medical staffs of the hospital for years past have been marked by mutual suspicion instead of friendly co-operation, and for this tho board has/ been chiefly, though doubtless not wholly, to blame. Such a state of affairs has undoubtedly reacted against the efficiency of the hospital. £or this reason, if for no other, an in"sion of new members into the board not only, desirable, but really essen"ih' the interests of the sick and of ; -. v as a whole. board'a administration do dealt with in a second article.