TUBERCULOSIS.

Otago Daily Times, Issue 19957, 26 November 1926, Page 6

TUBERCULOSIS.

ITS NATIONAL TREATMENT

REPORT TO HOSPITAL BOARD. The national treatment of tuberculosis was the subject of a lengthy communication to the Hospital Board last evening from the medical superintendent, Dr A. K. Falconer. The letter was as follows; — “Oji April 1, 1926, there came into force in Now Zealand a now Act making as a ‘law of settlement’ a three months' residential qualification for admission to hospitals and sanatoria instead of 12 months as previously, thus affording the general public greater facilities in making more general use of the various hospitals and sanatoria in New Zealand, and so instituting a stage further on the road to nationalising these institutions. As was anticipated, this innovation has a decided drawback in that it must materially adversely affect the financial position of the North Canterbury Board, the Otago Board, and the combined hospital boards administering the sanatoria in the South Island. Incidentally the Dunedin Hospital is similarly the hardest struck of all the general hospitals in the Dominion—the local ratepayers being called on to carry an unfair burden in providing accommodation for patients who are essentially, though not legally, residents of outside hospital board districts. s,, “The North Canterbury Board had this

problem before it at its last mooting, and the press report states that the following motion was earned: ‘That the Public Health Committee be asked to bring down a comprehensive report, covering the whole position regarding the sanatorium.’ Dr Blackmore is reported to have stated: ‘I have always held the opinion that tuberculosis is a national disease and ought to bo treated nationally. In my opinion a tuberculosis board should be set up in each island to deal with cases and enable them to be allotted to institutions.’ “This matter of the national treatment of tuberculosis was the subject of a remit which I suggested and drafted and which was forwarded by the Otago delegates for consideration at the conference of the four main hospital boards on July 13, 1922. The remit read : ‘That hospital boards generally throughout New Zealand be amalgamated for the treatment of consumption with a view to pooling the capital cost and maintenance thereof in proportion to the rateable capital value of districts.’ “The conference carried this remit, which was supported by the then Minister of Health (Sir Janies Parr), and also Dr Valintine (Director-general of Health). The North Island boards did not formally oppose it, though an indication was given that they were lukewarm in the matter, obviously because they are on a good financial wicket at present on account of the fact that the Government itself provides the capital cost and maintains the sanatoria in the North Island while the individual boards have that responsibility in the South Island—a position which has truly been described as iniquitous. (Note.—The cost of the Otaki Sanatorium was not provided exclusively by Government funds). Otago has always wished to hand the responsibility on to the Government—hut North Canterbury lias always been somewhat loth to part with the institutions it has so successfully managed The chairman of the Otago Hospital Board (Mr W. E. S. Knight) has made a pertinent observation that a hoard so handing over its institution should receive adequate financial recompense. “There is no doubt whatever but that Dr Blackmore’s suggestion is right (hat ‘tuberculosis is a national disease and ought to be treated nationally.’ I arn firmly of the opinion, however, as 1 think Dr Blackmore is, that it would not be \vise to make the treatment of tuberculosis entirely a State service. State services are naturally too inelastic and too subject to the dislocations of periodic political financial disturbance. The State and local authorities should remain co partners. There must ho some measure of political control of institutions maintained by local municipal rates or Government funds. Even American authorities arc now awakening to the fact that the best safeguard _ against partisan political control of public hospitals is a combination of the State and local municipal authority. In this respect the United States of America has a lesson to learn from New Zealand where partisan political control of public hospitals is as yet unknown.

“A practic.il scheme in the direction of carrying out Dr Blackmorc’s views—t.e., a national, universal and uniform tuberculosis service, was put on record in my letter dated July 19, 1922. The scheme has all the advantage of a national cfTort under local administrative control. An extract of my report dated Julv 19, 1922. is as follows; ‘in discussing the above matters (namely, the proposal contained in Dr Valintino’s letter of June 27, 1922, inviting the Otago Hosnital Board to join with the Ashburton, South Canterbury. Waitaki. South Otago, Southland, Wallace and Tiord, Vincent and Maniototo Hospital Boards in the establishment of a sanatorium at Waipiata) with the secretary of the Otago Board (Mr John Jacobs) an important suggestion was made by him that it would only be fair for the Government to allow this district the same rights as regards the Government sanatoria at Pukeora and Otnki as wore proposed to ho civen to the North Island Hospital Boards. This easily led to (lie suggestion (which I made as above that the whole of the sanatoria be pooled and the cost of treating tuberculosis bo borne by a special flatrate for the whole Dominion and your delegates to the hospital boards’ conference 1922. agreed to forward this proposal a? a remit for discussion at Wellington. “To carrv out the scheme I would suggest that four district tuberculosis boards bo sot, up. the members of which would bo nominated by the hospital boards in the several districts, and their duties w'onlj be, (o be entirely responsible for the administration of the sanatoria and the treatment of tuberculosis in their own -rcas. It would lead to efficiency if some co-optative members interested in tuberculosis treatment were associated, which would thus lead to some continuity in administration. Each district board would appoint one jionmedical member to form a National Tuberculosis Board of seven members, the other three being the Minister of Health (chairman), the Director-general of Health, and a medical practitioner to be appointed by the Minister after consultation with the Board of Health and the Council of the British Medical Association (N.Z. branch): the National Tuberculosis Board would be responsible for finance, and policy viewed broadly. It would advise the Minister concerning the special tuberculosis rate to be levied" The Minister now has the power to veto, and a place on the board would probably often prevent the necessity of exercising it. “Originally founded as a national State tuberculosis service in New Zealand in 1903 as a charge on the consolidated revenue, the department soon changed its policy, owing to the complaints in Parliament of the cost involved, and transferred the responsibilities of the treatment of tuberculosis to the hospital boards about 1908. This altered policy since 1909 has been carried out in the South Island, but the North Island still remains under the control of the Government’s leading strings. Owing to the unsatisfactory position, proposals have boon made from time to time for the treatment of tuberculosis to become again a national State service (vide Mr Quelch’s motion, Otago remit, Hospital Boards’ Conference, 1920*). But the department, while it cannot delegate its responsibility for policy and finance entirely, knows that it is considerably handicapped in administering institutions, and democratic local control is the spirit of onr age. The fault has been that a multiplicity of hospital hoards lias meant a multiplicity of independent uncorrelated sanatoria authorities, and the department’s policy has never become concrete. There has thus gradually been evolved a practical solution, such as given above, which will carry out the requirements of the hospital boards that it should be ‘uniform and universal’ in its operation (vide Dr Blackmore), and the suggetsion of the Minister of Health that his department regards itself as a half partner with the hospital boards. If 1 may be permitted to coin a label, the scheme may be described as a ‘uni lied hospital board and State Dominion tuberculosis service,’ with all the advantages of a national effort under local administrative control. To my mind the scheme is superior to a purely State national service, and a great advance on the present somewhat chaotic position. Should a State national tuberculosis service again eventuate the machinery and organisation proposed would fall naturally into lino and facilitate the change. In the September 1926 number of the Modern Hospital, Dr MacEaohorn recommends for New Zealand that the

“chiefly supervisory capacity of the Department of Health be superseded by a controlling function exercised by some central, non-political board. This board should be composed of representatives of

(1) the Government —the Minister of Health or the Director-general of Health —as well as additional representatives if so desired; (2) the hospital boards; (3) the New Zealand Branch of the British Medical Association. The sphere of the existing Dominion Board of Health might be extended to include control of hospitals as well as health activities under a broader name, such as the Dominion Board of Health and Hospitals." Were such a board called into existence it is obvious that it would be well able to supersede the National Tuberculosis Board as recommended above (the personnel of which is on similar lines to Dr MacEachern's suggested board) in controlling both the policy and finance of the prevention and treatment of tuberculosis. Until some such arrangement is made in New Zealand the administration of the campaign against tuberculosis is markedly handicapped through unnnecessarily faulty organisation. it was agreed to refer this report to the Remits Con initteo set up by the board, the Remits Committer; to report to the Finance Committee. Mr A. F. Qtielch emphasised that the effect of this three months' residential qualification would bo to throw heavy additional burdens on the board. The Chairman (Mr W. E. S. Knight) agreed that the Hospital Boards' Conference ought to take the matter up. Mr Quelch said that tho board ought to tako immediate action to put the matter before the Health Department. Otherwise their finances were going to be strained in a manner quit? unfair to their ratepayers. The board should prote?t direct. Mr Macdonald said that the chairman should approach tho Acting Prime Minister and put the matter clearly before him. Tho Chairman said he thoi'™ht it was a matter that should come before the conference. Mr Quelch said it should go to tho conference as well, but they would be outvoted at the conference as the new arrangement suited the small boards. Tho Chairman said he could see exactly what they were likely to bo saddled with. People would drift into tho district, reside there for three months, and then b 6 & charge on the district. That was never contemplated when the Act was being amended. In his opinion it had been hurriedly passed. On the motion of Mr "lelch, seconded by Mr Morgan, it was decided to write to tho department pointing out the way in which the new legislation would affect the board. *Motion bv Mr Quelch, Hospital Boards' Conference 1920: "That the whole of the control in connection with the prevention and treatment of tuberculosis be taken over by the Health Department''