CARE OF THE SICK

New Zealand Times, Volume XXXII, Issue 7027, 15 January 1910, Page 7

CARE OF THE SICK

PREVENTING ABUSES AND OVERLAPPING. PUBLIC AND PRIVATE COORDINATION. IMPORTANT SPEECH BY MR FOWLDS. PRESS ASSOCIATION. NEW PLYMOUTH, January 14. The Hon. George Fowlds, Minister iu Charge of tho Hospital's and Charitable Aid Department, in response to an invitation from the-"ldeal bodies concerned,: delivered an address in the Town Hall this afternoon to members' cf local bodies contributing to the . maintenance -of hospitals in .Taraaaki. 'The Minister dealt 1 in detail, with the liospital legislation passed during last session, and hospital administration generally, Mr Fowlds, - after thanking the people of the district for affording " him an opportunity to address this first meeting of local bodies iu the Doniinion with regard to the ■ purposes and scope of the new Hospitals and Charitable Institutions Act, reviewed the trend of social thought and development ' ; in. medicine and surgery that had marked tho past three decades, and said that ill framing the present-Act-all these matters had been borne in mind, - Not only, was provision made for'the care of the helpless, sick, and needy, in the various institutions, but also for their care, .and treatment throughout the Dominion: it was hoped also that there was sufficient elasticity: in the law to. allow public and private philanthropy to work hand in hand, and thus reduce to a minimum' overlapping nnd the abute of charity that was now going on, especially .in larger cities. ' '. '" . ", '',' THE NEW LEGISLATION. .'■' /■ ] Concerning tho Bill 'itself, Mr Fowlds said ho would deal with its main principles. The Dominion was divided into 36 "hospital districts. . Ho had hoped, it would have,..been ..possible ,to provide larger hospital districts for two special reasons, that the board of a large dis-> trict would be more likely to take a broader view of tlie requirements of the sick and needy than > a small district,; and be self-contained as regards the etitutions'necessary, namely— ''.''?■>'.'■ ■ (1) The base or main hospital. (2) Subsidiary and cottage hospitals. (3) Infection's diseases hospital. (4) Consumptive sanatorium or annexe. (5) Old people's home. ■ ' : (6) Chronic ward. (7) Maternity hospital or ward: It was quite beyond the means of the smaller hospital districts to undertake such vast responsibilities, but to a great. extent this could be obviated -,by: section G 6 of the Act, which enabled tiyo or more' hospital districts to combine for the. purpose of- erecting and ■ main-i taining institutions common, to a combined district. -For example, it would be absurd for. the Stratford or Hawera Board to each undertake the responsibility of erecting at an old men's home a consumptive annexe, and he congratulated these boards on having decided to combine with the Taranaki Board for the purpose-,of maintaining a,, consumptive annexe; -old people's home and a chronic. ward attached to tho latter. , BURDEN OF POOR.RELIEF.

/The other, argument in-favour, of .:. a large district was to' the fact that the burden of poor--relief was so uneven* ly distributed. Under the new law all boards had -control of charitable aid, as well" as..'h'6spitals • and * -kindred' -institutions. In some parts of the Dominion charitable aid and-hospitals had been administered by separate boards, ,-and this often led to confusion and disputes;' Happily,'- with* the' exception of certain institutions,-. ,to: be i supported indopen-j dently of. the ratepayers,, ''separate, institutions" were how abolished,;'"and with - them disappeared : one. of tlje,worst anomalies of the old law, all matters affecting'the helpless '': sick and needy being under the' control- of one board. Th© latter could decide ..where to,, send their acutely sick, their chronic';'and incurable' cases, their consumptives, etc.; nnd decide what patients should be treated in their , institutions and what patients should be treated at their own homes bv the various, agencies that, the board under the .new- Act had..power to ihvoke-.y ''''.'..' '.'' ' . " ''.'''"' : ':iSPEClAL KNOWLEDGE. ' : Under section 64 the board was enabled to appoint -committees,; including per T wraa who were not members, of the board. This'w'Wone ofithe "most; important se<M tion-s," for by its meahs" tho'board would be able to-call.to,its,aid persons having special experience in various social matters, for which the board-was directly or indirectly responsible' under the Taw-, whether as a member .-of. the board or committee, or whether as nurse or dis-; trict visitor. No scheme for_ the preventionor * relief of- : sickness or distress-could be regarded aa complete which did not give the fullest scope, to those well recognised !l but'' uhdeflnable attributes on which-■woman,,: andr woman alone,,.was endowed. '.-. ■,.,,- : ; ;.■■:■,...•. PESPONSißiLrriES.'.'■■'-.;.;..; ; Another very important section _w*as -83, .whereby a local body could waive- its responsibilities under the Health* Act to the Hospital Board,of.a,district. Ifemust be allowed .that a.:Hospital Board,, wh.ich was 'iespohsible foi'"tlie'cafe''and'treatment 1 of th'e'sick'of:h,"di«trict. andvhad, therefore, .to l>cUr. a large share Of the expense of treatment,' should also have some 'control, of the influences which '■werelikely l to-cause,-sickness.. No system of'hospital itreatment should be divorced from a system of domiciliary inspection'. He hoped that many of the country local authorities would take advantage of this- section. Uader-the. present ciroum r stances, partly, because, of the:. .number and' snvhllness of many 'of the" local bodies, and tlieir consequent want; of funds, it was next door to. impossible to bring about that uniformity in combatinsr. disease that was so essential if the att*uck were to-be..effectual. Wliat could'

the smaller road boards do in* the matter? The Minister commended the combining of. local authorities to pay the salary o£ a sanitary inspector, and advised that the appointment should bo made by the Hospital BcUrd, and as_ for this expenditure the Government paid a £1 for £1 subsidy, ar.il the local authorities would saveanoney by. the transaction. The sanitary inspectors, when under the control of the boards, would also perform the duties of inspectors of charitable relief, and report upon the circumstances surrounding the applicants for churitable relief, possibly saving much abuse of charitable aid. As a corollary to the board assuming. the responsibilities.ivouidsave money by the transaction. Health Act, a hospital surgeon would naturally : be expected to give advic© to the board and department of those influences -affecting the health of a district, and the inspector would .be guided by I his advice and directions. ••-. , MIDWIFERY. '-..■■.■:■.-/.. .

Midwifery training, a . maternity patient and her infant, had hitherto been considered outside the. responsibilities of hospital boards. In most countries where the decline in the birthrate had become apparent it had been recognised as inipjrutivo' of the State, to counteract this tendency. The late Mr Setldon recognised tiiis, and with the intention of a great statesman, caused to be established in the larger centres maternity homes--. known ■as "St. Helens Hospitals.". These institutions not only provided the beet possible treatment. for sonio 1000 mothers every year, but also for. the efficient training of some'so midwives yearly. The department was endeavouring to got. trained women to practise in those districts, but of the .126. midwives ■ turned out. from : St. Helens only a small number .were known .to be practising in the . backThey must ' try to counteract. this .tendency by. increasing the output of midwives,. and by. giving special encouragement to'country girls to. come: in -for training:, ; and go- back-to their districts to practise. , - ; MATERNITY WARDS.

In addition to, increasing the accommodation, for probationers ' ajt St. Helens and other maternity homes, they should provide maternity wards at country hospitals. To obtain the training necessary for midwifery certificate, an expenditure of some £%> is involved, and with a view to encouraging country girls to come in for training and go back to thoir, districts, the-department proposed to allow such girls to obtain their training fr«» of cost, provided they were specially recommended as suitable, persons by the hospital boards, and they guaranteed to practise in any part of their hospital district to which they might be,sent for at least .two years, an experiment. that was .well worth trying to-encourage. PAYMENT OP FEES.

"Midwives," continued: Mr Eowlds, "send for medical, assistance in difficult cases, as is incumbent on them under the regulations of the Midwives ■■ Act. Hospital boards should guarantee the. expenses if a doctor is sent, with a stated fee for attendance, and mileage could be arranged, and in the event of the husband being -, in a position to pay, the board could recover the fees'in the saimo manner, as fees are recovered for hospital "'maintehaneo. As regards infants, it is hoped that the system of district nursing will" embody tlie excellent work that hitherto has been only undertaken by the'nursing system initiated by Lady Plmnket. •; ~.; ~-." .;'■ ;■ -■;-. >-, - -'";'; DEPARTMENTAL CONTROL. < "All who have an intimate knowledge of; : our ' hospital : system - admit'/that:- o modicum of departmental control i«f necessary, particularly in regard to appointments' to intitutaons . arid - limiting ;unneceasary expenditure..';.-'.' The, department is very anxious for boards, to adopt a uniform 'system ' of keeping''accounts, as recommended bv tho recent Hospitals Conference in, the United .King-' ''doih... "As, in the old Act, the cost ,of relief granted by the board 1 constitutes a; debt.' and can be recovered:by. action, The new- is..more definite as to fixing 'respohsiliiiity With regard to main'tenanoe. With the exception, of the alberation,,i , u ~tho;mode. of men* subsidy, there is little- alteration from the, old. law -as regards-.the. financial powers - ; oif ! boards". A- contributory body which considers itself aggrieved by the cotttributio'a~demanded by"'a Hospital .Board, cam still appeal for an inquiry ■to ; be held*by 0/'commissioner'to be ap T pointed i by .tie-Minister,.!-,but',tie la.tr tor is hot "bound to give effect to the recommendation made. Boards may take land under tlie Public Works Act." .'*',; ,;.;; SOME SUGGESTIONS.,." ; '■ . | The ; Minister put forward suggestions as"''td th© :, *best- means of. bringing the Act into operation. He hoped the new system of election would bring to the front members of old „ boards who, had devoted much, time and thought to Die various,, problems with-which they had been , confronted. "It was . : hoped. ..that -boards ;J n ! oiikl ajjpoiiit "to thie persons of .-both sexes . who , had shown .. capabilities :..in -the •'■ - direction and control of - private philanthropic effort. It was in the hiffb.,est. d«gree .desirable.-thait-.where possible :Hospital .. .Boards-..;should ~, assume •;'..the "powers, 1 -'oi-''at any rate some of the powers, of a. looal authority under the . Public, Health ~. Aqt. Each boau-d, especially .' tliose m Ifigc centres, should set up three special , „ committees:—{a) ■■■■■■ . Imstitutdon-d Committee, <(b). Committee-'of Social AVel? fwre; (c) Committee of Public Health; The following officers would be required to carry out the various duties of the.i board and lits. branches;:—Medicaid offif cers: The number, appointed being acr'l cording to (he requirements Of the district. A deituite._fee.and mileage should bo arranged for medical men attending ■ indigent cases 'Or'-'dn'tlie 'requisition'-'of midwives.to attend case's "of difficult labour under the midwives'. regulations, "Inspector :'"Those should be regarded as s ! 'hand.r; : men,V> and should the duties of sanitary inspector .and: poor law officer. District Nurses': It might be necessary to make"'more"'than' one I appointment in some district hospitals; in fact, it .was hoped that" their salaries would bo mostly recovered, from the rbette-r-to-do who might' avail themselves of their services. v .He. congratulated.the Taranaki Board on being the first to api>oint -a district nurse. It was not necessary, and possibly would not >be wise, to make all .the appointments that he nad suggested ' straight away.. } Let them appoint their best-men, ; bring 'the. new law ,Jnto.Jbei.ng,..,and, administer it with fearlessness, lionesty "and vigour, and he. had little fear of the result if the people of the Dominion- would sustain the interest now shown in. their institutions and^-keep-ever—before them sympathy for the unfortunate, based on the soundest dictates of the heart and on common-sense. ,