HOSPITAL CRISIS

New Zealand Herald, Volume LXXII, Issue 22047, 1 March 1935, Page 10

HOSPITAL CRISIS

THE BOARD'S BEGGED BLUNDERS OF THE PAST OVERCROWDING PROBLEM ... ' ' . A NO PLANNED SOLUTION 11. In an article published yesterday a case was made out, on general considerations, for infusion of new blood into the Auckland Hospital Board at the local body elections two months hence. It is now proposed to deal with various aspects of the board's past and present administration. Although the Auckland Hospital is by far the largest in the Dominion, it occupies buildings that are probably worse arranged and more inconvenient than those of any other city hospital in this part of the world. The buildings are not only heterogeneous in external design, and in many instances wrongly planned, but they are also awkwardly scattered over the site, so that patients when moved about are exposed to the weather. Whenever it rains an ambulance has to be used for taking patients in distant blocks to and from the operating theatres. The children's wards are so placed that their ends face north and south and urgently needed sun balconies cannot be erected.. The Wallace block, built at a cost of £90,000, was planned for surgical work and altered for medical work while under construction. It has been the subject of unabating criticism from the medical staff ever since it was erected, airid is generally ' regarded as an expensive blunder. The distant isolation block, costing nearly £40,000, was empty and unused for some years, and is now occupied by orthopaedic cases, which are taken at much inconvenience to the operating theatres in the Costley block, although there is a fully equipped theatre in the building. Administrative Confusion These conditions add much to the work of the doctors, nurses, porters and kitchen staff, and make administration far more difficult than it should be. The chairman and a number of the members of the present board cannot be held free from blame for the-de-fective policy, or lack of policy, wihich has caused these troubles, for two, if not three, of the buildings mentioned were erected after 1918, when Mr. Wallace assumed office as chairman, and with the full concurrence of some of the fitting members. It is no exaggeration to say that the board in that period has entirely failed, and apparently has not even attempted, to oraw up a plan for the orderly development of the hospital. Neither has it taken any effective steps to provide a remedy for its own mistakes.

Admissions to the hospital have linen increasing at the rate of several hundred a year—a good deal more rapidly in proportion than the population of the hospital district. The number in the past year is believed to have exceeded 11,000. The hospitajl is chronically overcrowded, and medical men are not alone in asserting that much administrative confusion exiijts. This is detrimental to the welfare of the patients and must affect the standard of clinical work done. Patients are stated to be placed in whatever beds happen to be available, as the dispersal of wards makes it difficult to transfer patients from one to another. Cases of the same type are not brought together as they should be, and members of the honorary and resident sfciiffs spend too much of their time in travelling between wards. Patients Who Should be Moved On the matter of overcrowding Ihe board has been criticised for lack of; policy by members of the medical profession for several years past. This oj;»en criticism is due to the fact that it has consistently ignored suggestions that have been made to it by its own officers and other doctors. One main ground of attack is that the hospital is used to provide beds i!or several classes of patients who should not be accommodated in a general hospital. These are (1) chronic castes, especiallj" old people, who require some nursing, but very little medical attenp tion; (2) convalescents, of whom the same may be said; (3) patients, including "walking" cases, who need no nursing and only intermittent medical attention; (4) patients admitted for observation; (o) tuberculosis cases. All these could and should be dealt with elsewhere at much lower cost to the board and often with greater beiriefit to themselves. Need for Convalescent Homes In the hospital at preseut are a number of old people whose' proper place is tho Auckland Infirmary. The latter is under a committee of its own, with no responsibility to the hospital. This committee, not unnaturally, prefers to admit old people from outside under pressure from the public rather than to take charge of those who are already in the care of the board.

Convalescents, according to the standard practice of the great English hospitals, are removed as soon as possible to homes at the seaside, where pleasant surroundings help their recovery and where they can be accommodated! in inexpensive buildings at much lower overhead and maintenance cost than in a general hospital. As regards the third category, doctors tyssert that if the patient's home surroundings were investigated it would often be found sufficient if he Jittended at the hospital for occasional treatment. Similarly, many persons are admitted for preliminary examination and diagnosis which could be carried out perfectly well if there were an out-patient department reserved strictly for prospective in-paticni;s. Such a department the board has consistently and even heatedly refused to provide. Two Indefinite Schemes! It has been maintained for some years that the average stay of patients in the Auckland Hospital is too Ion;;;, for the reasons named, but the board has always resisted the charge. However, the board deserves credit for having reduced the average from approximately 21 to 21 days, possibly "> pa;:t by establishing a small home nursinu service. The medical critics, neverth> loss, hold to the view that under Auckland conditions the average should net exceed 14. days. The only direct remedy for overcrowding proposed by the board is a schema, at present nebulous, for adding a storey to some of the infirmary buildings at a suggested heavy cost of about £.'10,000. The doctors have ail along submitted that there would be enough accommodation at the infirmary for chronic cases if it were used for its true purpose and preference were given to the most deserving. The board's scheme for erecting a chest hospital to servo the Auckland district is generally approved, but i - will do less to relieve the congestion at tlio general hospital than almost, any other that the board couic! undertake. , , A further article will deal with the relations between the board and the. medical staffs.