HOSPITAL AND CHARITABLE AID

Otago Witness, Issue 2914, 19 January 1910, Page 62

HOSPITAL AND CHARITABLE AID

NEW LAW EXPOUNDED. MR FOWLDS’S ADDRESS. NEW PLYMOUTH, January 14. The Hon. George Eowlds (Minister in charge of the Etospitals and Charitable Aid Department), in response to an invitation from the local bodies concerned, delivered an address in the Town Hall this afternoon to members of local bodies contributing to the main--tenance of hospitals in Taranaki. The ‘Minister dealt in detail with the hospital legislation passed during the last session and hospital administration generally. Mr Eowlds, after thanking the people of the district for affording him the opportunity to address this, the first meeting of local bodies in the Dominion, 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 the past three decades, and said that in framing the present act all these matters had been borne in mind. Not only was pro- > Tion made for the care of the helpless sick and the needy in the various institutions, but also for their care and treatment throughout the Dominion. It was hoped, also, that there was sufficientelasticity in the law to allow public and private philanthropy to work hand in hand, and thus reduce to a minimum the overlapping and abuse of charity that was now going on, especially in the larger cities. Concerning the bill itself, he said he would deal with its main principle. The Dominion was divided into 36 hospital districts. He had hoped it would have been possible to provide larger hospital districts, fo'r the two special reasons that the board of a large district would be more likely to take a broader view of the requirements of the sick and needy than a smaller district, and be self-contained.- As regards the institutions necessary —namely, (1) the base or main hospital, (2) subsidiary and cottage hospitals,. (3) iniectious, 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 smaller hospital districts to undertake such vast responsibilities, but to a great extent this could be obviated by section 56 of the act, which enabled two or more hospital districts to combine for the purpose of erecting and maintaining institutions common to combined districts. For example, it would be absurd for the Stratford or Hawera Board to each undertake the responsibility of erecting an old men’s home or consumptive annexe, and he congratu-, lated 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, to be attached to the latter. The other argument in favour of a large district was due to the fact that the burden of our poor relief was so unevenly distributed. Under, the new law all the boards had control of charitable aid as well as hospitals and kindred institutions. In some parts of the Dominion charitable a iyl and hospitals had been administered by separate boaixls, and this often led to confusion and disputes. Happily, with the exception of certain institutions to be supported independently of the ratepayer, ‘‘separate” institutions were now abolished, and with them disappeared one of th-e worst anomalies of the old law. All matters affecting the helpless sick and needy being under the control of one board. - the latter could decide where to send their acutely sick, their chronic and incurable cases, their com sumptives, etc., and decide what patients should be treated in their institutions and what patients should be treated at their own homes by various agencies that the board under the new act had power to invoke. Under section 64 a board was enabled to appoint a committee including persons who were not members of the board. This was one of the most important sections, for by its means a 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 law, whether as member of a board or committee, or whether as nurse or district visitor. No Scheme for the prevention of relief of sickness or distress could be regarded as complete which did not give the fullest scops to those well recognised but u.ndefinable attributes, in which woman, and woman alone, was endowed. Another very important section was S 3, whereby a local body could waive its responsibilities under the* Health Act to the hospital board of the district. It must be allowed that the Hospital Board, which was responsible for the care and treatment of the sick of the district, and had therefore to bear a large share of tbs expense of treatment, should also have some control of the in fiuences which were likely to cause sickness. No system of hospital treatment should be ’divorced from a system of domiciliary inspection. He hoped that many of the country local authorities would take advantage of this section. Under present circumstances, partly because of the number and smallness of many local bodies, and their consequent want of funds, it was next door to impossible to bring about that uniformity in combating disease that was so essential if the attack were to be effectual. What could the smaller road boards do in the matter? The Minister commended- the combining of local authorities to .pay the salary of a sanitary inspector, and advised that the appointment should be made by the Hospital Board, and as for this expenditure the Government paid a- pound for pound subsidy. The local authorities would save, money by the transaction. The sanitary inspectors, when under tire control of hoards, would ixusj perform the duties Oi

inspectors of charitable relief, and report upon the circumstances surrounding an applicant for charitable relief, possibly saving much abuse of charitable aid. As a corollary of the board assuming the responsibilities of the local authority under the Health Act, the hospital surgeon would naturally be expected to give acL advice to the board and the department of those influences affecting the health of the district, and the inspector would _b& guided by his advice and directions. Mid wifery training and the maternity patient and her infant had hitherto been con sidered outside the responsibilities of hospita 1 boards. In most countries where the decline in the birth rate had become apparent, it had been recognised as the imperative duty of the Stale to counteract this tendency. The late Mr Sedclon recognised this, and, with the intuition of a"great statesman, caused to be established in the larger centres maternity homes, known as St. Helens hospitals. These' institutions not only provide the best possible treatment for some 1000 mothers every year, but also for tire efficient training of some 50 midwives yearly. The department was endeavouring to get trained women to practise in these districts, but of the 125 turned out from St. Helens only a small number was known to be practising in the backblocks districts. They 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. In addition to increasing the accommodation for probationers at St Helens and other maternity homes, they should provide maternity wards at country hospitals. To obtain the training necessary for a midwifery Certificate an expenditure of some£2s is involved, and with a view of encouraging country girls to come in for training,' and go’ back to their districts, the department proposes to allow such girls to obtain their training free of cost, provided they are specially recommended as suitable persons by hospital boards, and that they guarantee to practise in any part of their hospital district to which they may be sent for at least two years. An* experiment that would be well worth trying would be to encourage widwives to 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 of the doctor sent in. A ’ stated fee for attendance and mileage could bo arranged and in the event of husband being in a position to pay, the board could recover the fees in the same manner as fees are recovered for hospital maintenance. As regards- the infants, it is hoped that a system of district nursing will embody the excellent work hitherto only undertaken by the nursing system initiated by Lady Piimket. He thought that all who have an intimate knowledge of our hospital system would admit that a modicum of departmental control was necessary, particularly with regard to appointments to institutions and limiting unnecessary expenditure. The department was very anxious for boards to adopt a uniform system of keeping accounts, as recommended by the recent Hospitals Conference. In the. United Kingdom • the cost of relief granted by the board constitutes a debt, and can be recovered by action. The new law, however, is more definite as to fixing the responsibility with regard to maintenance. With the exception of an alteration in the mode of allocating the Government subsidy, there was little alteration from the old law as regards the financial powers of the boards. A contributory which considers itself aggrieved by contribution demanded by the Hospital Board can still appeal for an inquiry to be held by a commissioner, to be appointed by the Minister, but the latter is not bound to give effect to the recommendation made. Boards may take land under the Public Works Act. Suggestions as to the best means of bringing the act into operation were : —(!) The amalgamated departments of Hospitals, Charitable Aid, and Public Health should be the central authority, and duties of its officers should be extended to meet the increased responsibilities. (2) It was hoped that the new system of election will bring to. the front members of the old boards who have devoted much time and thought to the various problems with which they have been confronted. (3) In addition to the above, it is hoped that the boards will appoint to the committees persons of both sexes who have shown capabilities in the direction and control of private philanthropic effort. (4) It is in the 'highest degree desirable that, where possible, hospital boards should assume the powers, or, at anyrate, some of the powers, of the local authority under the Public Health Act. (5) Each board, especially those in the large centres, should set up three special committees—(a) Institutional Committee, (b) a committee of social welfare, (c) a committee of public health. The following officers would be required to carry out the various duties of the board and its branches :—Medical officers, the number appointed being according to the requirements of the district. A definite fee and mileage should be arranged for medical men attending indigent cases, or, on the requisition of mid wives, to attend cases of difficult labour under the midwives’ regulations. Inspectors — These should be regarded as “ handy men,” and should combine the duties of sanitary inspector and poor law officer. District nurses —It may be necessary to make mope than one appointment in some district hospitals. In fact, it is hoped that their salaries will bo mostly recovered from those better to do who may avail themselves of their services. He congratulated the Taranaki Board on being the first to appoint- a districtnurse. It was not necessary, and possibly would -not be wise, to make all the appointments that he had suggested straight away, but there was now the new law that some had so strenuously fought/ for. Let them appoint their best men, bring it into being, and let

them administer it with fearlessness, honesty, and vigour, and he had little fear of the result if the people of the Dominion would sustain the interest now shown in the institutions and keep ever before them that sympathy for the unfortunate which was based on the soundest dictates of heart and common sense.

EXTENSION OF BENEFITS. AUCKLAND, January 14. The Hon. G. Fowlds, on being interviewed, said the first election under the new Hospital Act takes place about March, when each contributory local authority will elect representatives according to population and rateable value. The nominative system will be abolished, and the board members elected by, the ratepayers. The Minister hopes to see hospital boards take over from the local bodies the responsibilities in regard to public health. Under the provisions of the new Act he hopes to see maternity wards provided at all the country hospitals with a view to encouraging country girls to come in for training and go back bo their districts to practise. He proposes to allow such girls to obtain training free of cost, provided they are recommended by a hospital board and guarantee to practise in. any part of the hospital district to which they may be sent for at least two years. St. Helens nurses will also be allowed to finish the midwifery training in the backblocks.

The Minister hopes for excellent results from the system of setting up special committees of public-spirited people in connection with hospital boards.