HOSPITAL REFORM.

Timaru Herald, Volume CXXXVI, Issue 19105, 10 February 1932, Page 9

HOSPITAL REFORM.

EIGHTEEN BASE HOSPITALS. EIGHTEEN HOSPITAL DISTRICTS. BENEFITS OF THE CHANGE. (Specially Written for “The Timaru Herald” by R. Campbell Begg.) Forty-five hospital districts and forty-five hospital boards exist to-day. Nine of these boards serve small populations of from 2000 to 6000 people, fifteen of them have less than 10,000 people in their districts. These fifteen boards look alter a total of 81,000 people (1930 statistics). On the hospital bed basis per thousand laid down by the Conference of Rural Hygiene held last year under the auspices of the League of Nations, namely, two per thousand, the number of beds required for this population is 162. The minimun number of hospital board members permitted by the Act is eight, so that it requires at least 120 board members to look after this population cf 81,000 people, or almost one member per bed on the Geneva Conference scale. How little standardised hospital service is may be illustrated by comparing one hospital district with a population of about 5000 (1930 figures), two small hospitals with a total number of 24 beds and an average of 11.5 patients (fewer than many small private hospitals looked after by a nurse), whose chairman draws an hon- , orarium of £IOO a year, and another | hospital district with a large area, a ! population of well over 100,000, or as j many as seventeen other boards’ areas I put together, five institutions, and i nearly 400 beds, where the chairman ; draws the same honorarium of £IOO. Efficient Treatment. j In only thirteen of these hospital boards’ districts does there exist a centre of population of 12,000 or over, which is considered the minimum for the conduct of an efficient Class A base horjpital. In many the largest centre is a township of a few hundred people with one resident doctor for this and the surrounding district. No patient can be transferred from one of these districts to a more fortunate one with a base hospital without a good deal of .[ formality, including a guarantee to the ; latter that thfe full charge for main- | tenance will be paid, even although the smaller board may itself recover nothing from the patient. The practical inability of residents of the smaller districts to enter these hospij tals, that is. to receive efficient diagi nosis and treatment in chronic and many acute conditions, is recognised and deprecated by the Department of Health, which administers the hospitals. To quote from the appendix to the annual report of 1927, page 6 (the . comments in brackets are mine): "To convert into a thoroughly equipped modern hospital at least one institution in each of the 47 districts (the number has been reduced to 45 since then) would cost more than the Dominion could afford or would indeed be warranted. (It would also be impossible with the medical resources avail- | able.) The tendency therefore is for S patients of the smaller districts to enj ter the .... base hospitals of their neighbouring district, which results in innumerable disputes between the boards concerned. . . . This fee (pay-

able for maintenance by the smaller to the larger board) in no case represents the aotual full cost of treatment. The board receiving the account, however, resents the patient not having availed himself of the hospital facilities in his own district. ...”

Nothing could more clearly show that electors of small districts are disfranchised, as it were, from receiving efficient base hospital treatment. It is proposed to reduce the hospital board districts to eighteen, of which thirteen would contain within their bounds a Class A base hospital, while five would have to be content with a Class B base hospital. To complete the scheme the additional proposal is made that four metropolitan areas be constituted, based on the four main cities of the Dominion. These would be at the disposal of the base hospitals to fill in the gaps which would arise in regard to facilities for certain forms of diagnosis and treatment, more especially felt by the Class B hospitals.

Each of these hospital districts would then be able to provide an effective decentralised administration of its own with cottage hospitals and district hospitals for the treatment of simple cases and acting as feeders to the base hospitals where more difficult cases were concerned. They would be able to maintain strategically placed district nurses with a bed or two for urgent cases pending transport to the base. They could place ambulances at suitable points, drivers to be arranged for from local police or fire brigade officials, or by private garages under arrangement. Proper lines of communication by telephone, telegraph, or wireless would ensure the complete linking up of the inhabitants with the ambulance stations and hospitals. All this work could be done much more effectively by strong boards in charge of large districts than by a central administration at Wellington hampered by the attempt to co-ordinate the activities of numerous small boards operating in the same area. The main object would, of course, be to land all cases with the utmost rapidity at the base hospital, at the same time seeing that prompt help was available on the spot. Slight cases would be treated at outlying stations, and the cost of transport and the inconvenience to the patient avoided. Reform Overdue. The advantages of this arrangement from every point of view are so numerous and so obvious that it is amazing that the existing conditions have been allowed to continue. Some of the most important are as follows: (1) Better Hospital Boards.—Of the 40 or 50 board members now controlling a series of small districts only eight to twelve of the most experienced would be on the new board. (2) Better Superintendence.— Only ~~ good superintendents required instead of forty-five. These could be well paid and supervise and co-ordin-ate in one group all the district and ; cottage hospitals, communications and | transport facilities, as well as the base hospitals. Administration would thus be kept free from actual metrical work. (3) House Surgeons and Junior Medical Staff.—Sufficient would be available. They would only be used at base hospitals.

(4) Hospitals Association.— This body re-constituted to give equal representation to the administrative and medical side would become a valuable organisation to standardise staffing and supplies.

(5) Improvement of Nurses’ Training Schools.—The Class A base hospitals

would be the centres for nursing education. There are many unsuitable nurses' training schools among the 33 at present existing. The quality and supply of trained nurses would be better regulated. (6) Facilities for Research and Progress.—The system of metropolitan hospitals closely linked to a group of base hospitals, would put New Zealand on an equal basis in these respects with countries with larger and more concentrated populations. The reform is overdue. The people of the Dominion should see that it is no longer delayed.