Hospitals Conference

Timaru Herald, Volume CXLIII, Issue 20667, 4 March 1937, Page 8

Hospitals Conference

Yesterday’s Business

Many Remits Passed

The general conference of the Hospital Boards’ Association of New Zealand was continued in Timaru yesterday. The official opening took place on Tuesday night, but the main business of the conference was not taken until yesterday. The greater part of the morning was devoted to domestic matters, but later good progress was made with the consideration of the remits, of which there are a large number. The conference was addressed during the day by Sir Louis Barnett, president of the 'Australasian College of Surgeons, and by Dr. A. Kidd. The conference will continue this morning, and this afternoon delegates will be taken for a motor drive.

Delegates Present The following delegates were present: Messrs T. S. Houston (Mangonui), C. F. Miller (Bay of Islands), P. R. Walden, W. A. Haden (Kaipara), J. A. S. McKay, A. C. Symons (Whangarei). Rev. C. Wood, Messrs W. A. Bishop, G. T. Parvin. E. H. Potter, J. Waddell, H. A. Somerville, Mrs A. G. Anderton, Dr. J. W. Craven (Auckland), J. J. Ryburn, H. W. Wilson, A. C. Burgess (Waikato), P. Lumley (Thames), L. R. Wilkinson (Tauranga), J. W. Summer (Bay of Plenty), M. T. Trafford, C. A. Harries (Gisborne), R. A. Rees (Wairoa), C. O. Morse (Hawke’s Bay), L. Stein, W. Dobson (Dannevirke), S. Vickers, A. M. Williams (New Plymouth), J. Anderson, T. Penn (Stratford), A. L. Campbell, C. Harrison (Hawera), C. R. Honeyfield (Patea), W. E. Broderick (Wanganui), W. M. Howell, A. J. Phillipps (Palmerston North), J. Glover, A. H. Carman, W. T. Gray, J. B. Cook, F. Castle, Mrs Blake, Mi’s S. Snow, Dr. A. R. Thorne (Wellington), J. F. Thompson, N. Lee (Wairarapa), A. J. Gavin. G. Mitchell (Marlborough), Major R. Dagger, C. P. Chapman (Nelson), T. W. Duff, F. McCabe (Westland), Hon. W. H. McIntyre, E. M. Powell (Buller), J. B Auld (Inangahua), J. Smeaton, J. D. Kelly (Grey), H. J. Otley, L. B. Evans. W. R. Spencer, W. S. Wharton, Mrs T. Green (North Canterbury), W. G. Gallagher, A. E. Prentice (Ashburton), E. Macdonald, H. G. Naylor (South Canterbury), J. Rodman, (Waitaki), J. W. Dove, A. F. Quelch, W. A. Ross, J. Jacobs (Otago), A. Rennie, Hon. F. Waite (South Otago), J. Ritchie, P. D. Edmonds (Vincent), B. A. Todd (Maniototo), T. Golden, T. Pryde (Southland), J. H. Smith, G. Cassells (Wallace and Fiord). Annual Report The report of the transactions of the executive since the last Conference in Napier in 1935, stated that the Executive had met upon five occasions since the last Conference and the president and members had several interviews with Ministers of the Crown and with State Departments upon matters affecting Hospital Boards and their administration. Conferences were also held with the representatives of the Municipal and Counties Associations upon the question of hospital finance and rating for hospital purposes; with the British Empire Cancer Campaign (N.Z. Branch) in connection with equipment and organisation; with the Directors-Generai of Health and Mental Hospitals in connection with rest homes and the care of certain classes of aged persons; and with the N.Z. Crippled Children Society with reference to co-operation.

An early opportunity was taken to p: :sent to the Government the proposals which the conference adopted for the institution of a compulsory national health insurance scheme embracing a complete health service. The proposals from the conference had evoked considerable Interest and the report which had had wide circulation had formed a useful basis for further investigation by the Government into the possibilities of such a scheme. The then Minister of Health advised by letter that "the Government appreciated the importance of the question and was taking steps to have the proposals investigated." A committee was set up by the Government early in 1935 to report on national superannuation and health insurance and though limited by time and scope, the report of that committee was favourable to the principles of a national compulsory health insurance scheme. As a plank of the present Government’s election programme the possibilities of the scheme had been actively explored. The committee set up by the Government had Issued and had obtained answers to a general questionnaire upon various phases of the scheme and was at present engaged in collecting further evidence with a view to formulating proposals as the basis of legislation.

The answers to the general questionnaire which were submitted by the Executive are published in the January 1937 issue of the Association’s Journal. These statements were made in terms of the report and resolutions of conference. The Executive had great pleasure In conveying to those members of the medical profession who rendered valued help In framing the report the following resolution of conference: “That the conference expresses its appreciation of the assistance rendered by the members of the British Medical Association who cooperated with the Executive in framing the report on national health insurance.”

The Incidence of hospital taxation had had much criticism from time to time and arising out of the resolutions passed at conferences of the Municipal and Counties Associations a meeting was convened in February of last year between representatives of the Municipal, Counties and Hospital Boards’ Associations. The various proposals which had been advanced as advocat-

ing an alteration in the method of assessing the levies on the local contributing authorities were under discussion. These proposals which included “levies on a population basis,” levies on half population and half capital value, taxation on income salaries and wages and other proposed changes were all struck out in favour of the following unanimous resolution: “That the Government be urged to promote a compulsory national health insurance scheme for medical dental and hospital treatment. That the financing of such a scheme be met by compulsory contribution from employers and employees, subsidised by the Government, and that provision be made for the inclusion of workers on their own account—that is, farmers and small business men.” Hospital Legislation By the Hospitals and Charitable Institutions Act 1936, some important legislation was brought into force. The Executive was indebted to the Minister of Health. Hon. P. Fraser, for his courtesy in affording an opportunity for discussing with him the several proposed amendments to the Act. A review of the Amending Act is published in the January 1937 Issue of the Association’s Journal. One important provision was that contained in Section 2 which clarifies the position in respect of the liability of Hospital Boards in damages for the negligent treatment of patients. This legislation recognised the principle decided by the Court of Appeal in Logan versus the Waitaki Hospital Board, and gave an effective remedy to the patient who might suffer at the hands of any person employed by a Hospital Board whether in an honorary capacity or not. The patient, of course, still had to prove negligence as formerly. By Section three as airending Section 77 of the principal Act, Hospital Boards were fixed with the definite responsibility for providing transport in non-infectious cases. Illness of Nurses Section 4 of the 1936 Amendment had been described by the Minister as a very tragic and important clause enabling Hospital Boards to make provision for nurses who, in the course of their duties, contract pulmonary tuberculosis. Legal opinion had indicated that a Hospital Board had no liability in respect of such cases and consequently could do little to fulfil a moral obligation for lack of legal authority. The desire of Hospital Boards in this connection was expressed in the remit brought to the last conference by the Otago Hospital Board and which was referred to the Executive for action to be taken to remedy the existing unsatisfactory position. The remit was: “That the Conference of Hospital Boards take into serious consideration the question of infectious diseases contracted by members of the nursing staff while on duty and that if necessary, the Government be asked to promote legislation with a view to infectious diseases contracted by members of nursing staff on duty being looked upon as occupational diseases, and that it be compulsory for Hospital Boards to provide for the future of such members of their staffs, either by insurance or accepting their own responsibility in the matter.

Previous Inquiry indicated that it was impracticable to extend the Workers Compensation Act to meet such cases In view of the fact that tubercular disease for example might be contracted outside of employment and that it was rarely if ever possible to definitely establish the source and time of infection. It was, moreover, the opinion of the Minister that It was more appropriate to make provision in the H. and C.I. Act so that Hospital Boards would have discretionary power to provide an allowance after taking the circumstances of each case into consideration. Pensions Most of the resolutions of the last conference had found expression in the pensions legislation which was introduced last session. The Executive, at an Interview with the Minister of Health, Hon. P. Fraser, last August, conveyed the thanks of the Hospital Boards to the Government for the reforms which had been advocated at successive conferences. The improvement in the old age and war pensions, the recognition of the deserted wife under the Family Allowances Act and the institution of the invalidity pension, which were some of the important reforms introduced by the recent legislation were indeed welcomed by Hospital Boards as placing a most unfortunate section of the community in a more dignified position than that of having to rely wholly or partly upon charitable aid. It was hoped that further consideration will be given to a modification of the disqualification for offences provision of the Pensions Act so as to avoid undue hardship to the applicant who had reformed. The Director-General of Health and the Director-General of Mental Hos-

pitals met, the Executive in conference upon the * question of more suitably providing for certain cases of aged persons of which class there were some 280 as in-patients of mental hospitals and admissions yearly amounted to 80. Agreement was reached upon a proposal for the future that the mental hospitals medical officer of the district should be on the honorary staff of the hospital in order to assist with his advice in determining what cases are suitable for admission to old people’s homes.

The question of Hospital Board debentures being made trustee securities had been actively followed up. Certain difficulties had presented themselves but at this stage the Executive appreciated the efforts of the present Minister of Health In seeking to give effect to the wishes of Hospital Boards in this matter. The position would be further discussed at the conference. Industrial Accident Cases The Minister of Labour had advised that he hoped to bring down a comprehensive measure dealing with the Workers’ Compensation Act and that he would endeavour to give effect to the desire of Hospital Boards as expressed in the resolution of conference: “That the Government be urged to amend the Workers’ Compensation Act by increasing the medical allowance from £1 to £25 against which a charge may be made for hospital fees.” Cancer Campaign Society The president of the New Zealand Branch, British Empire Cancer Campaign Society, Sir James Elliott, together with Drs. P. D. Cameron and E. Lynch, met the Executive to discuss recommendations which have since been given effect to, at the four main hospitals, in connection with improved equipment and facilities. An important decision had been made which was a very generous offer from the Cancer Campaign Society to afford financial assistance in approved cases to bring cases from country districts for treatment at base hospitals. The Cancer Campaign Society had expressed concern about the ability of indigent country sufferers of cancer to attend a centre for treatment, having gained the impression that there were, especially in the more remote country districts or backblocks, many real or suspected cases of cancer who, because of financial difficulties, were not availing themselves of the special consultation and treatment service provided at the main centres. The Society recognised that country Hospital Boards accept responsibility for the maintenance expenses in a base hospital of such patients as require special treatmen such as can not be provided out of the limited resources of the small hospitals, but it was also realised that certain extra expenses were involved in the transport and accommodation not only of the patient but also an accompanying relative or friend. The proposal for a group scheme of insurance to cover the insurable risks of Hospital Boards would be submitted to the conference. The subjects touched upon in the report were some indication of the wide scope of the Association’s activities. The centralisation of matters to be presented to the Government Departments or to the Ministers of the Crown for which legislation was sought, made for economy in time and effort. Through being organised, the Hospital Boards had a medium of expression of the concerted views.

It was desired to acknowledge fully the courtesy and assistance at all times extended to the Association by the Department of Health and other Government Departments. A grant of £4O from the Government was gratefully acknowledged. The income and expenditure account for the year ended March 31, 1936, and certified balance sheet at that date has been circulated to members. A reserve of £3OO at the end of the present year, March 31, 1937, has been budgetted for. Presidential Address In moving the adoption of the report of the Executive, Mr Otley said the full attendance of members and officers of Hospital Boards was an indication of the interest in the affairs of the Association. The conferences had always been held in an atmosphere of goodwill and mutual understanding, and there existed among the Boards a spirit of co-operation which was not excelled by any other organisation. The president desired to convey the thanks of the executive to all Hospital Boards for the support and co-operation which had been so readily accorded the Association and thanks were due to the

Minister of Health and the officers of the Department of Health who had always been ready to give advice and assistance.

Since the last conference in Napier, some remarkable changes had been Experienced in hospital activities. The depression years were curiously accompanied by a falling off in the numbers of patients treated. Whether the effects of the depression were just being felt in the health of the people or whether advanced methods had popularised the institutions was not known but the accommodation of practically every hospital was fully taxed, both with patients and staff. Many Boards had building programmes under way the figures of rvhich would a few years ago have staggered the imagination, but it was plain that as the hospitals became more and more popular as units in the social structure so the hospitals would have to move forward to meet the persistent demands for adequate care and treatment of the sick and suffering.

It was gratifying to know that many of the resolutions of the last conference respecting pensions, had found expression in recent legislation and that the Government was actively investigating the proposals for a scheme of National Health Insurance as advocated by hospital boards. The motion was carried. Chairman Appointed In the unavoidable absence of the president of the Association (Mr W. C. Wallace), Mr H. J. otley (vicepresident, North Canterbury) was elected to the chair. Mr Otley said that it was unfortunate that Mr Wallace could not be present, because for many years he had taken a very keen interest in the affairs of the Association. However, he (Mi’ Otley) had been appointed to the chair, and he would endeavour to do his best. Position of President Nominations were called for the election of officers, and there were several nominations for the position of president. This created a complication, as the nominations for vicepresidents were required to be taken immediately. The secretary (Mr Cannons) pointed out that if a candidate for the presidency was unsuccessful he would be ineligible for a position as vicepresident. It was suggested that the office of president should be decided immediately, and the way would then be left clear to elect other officers. A member suggested that the stand-

ing orders should be suspended, so as to dispose of the necessity for printed ballot papers, and a vote was taken on this course. As there w’ere two delegates opposed, the motion was lost. At the request of a delegate, the secretary read the rule dealing with the election of officers. Mr Howell (Palmerston North) withdrew his opposition, and the conference proceeded to elect a president.

The result of the ballot favoured Mr J. W. Dove (Otago). He took the chair and thanked delegates for the honour they had conferred on him. He said that the future contained many possibilities regarding hospital affairs, and he would do his utmost as present. Politics were unknown to them as representatives of hospital boards, and so long as the Government would listen to their requests then he, as president, was the man to work in their best interests. The vice-presidents elected were Rev. W. C. Wood (Auckland), Messrs H. J. Otley (North Canterbury) and J. Glover (Wellington). Executive officers elected were—Hon. W. H. Mclntyre (Buller), Messrs E. Macdonald (Timaru), C. O. Morse (Napier), J. A. S. McKay (Whangarei), and W. G. Broderick (Wanganui). Tributes were paid to the good service rendered by the retiring president (Mr Wallace). Remits Considered A large number of remits were discussed by the conference during the day. “That in the event of Section 92 of the Hospitals and Charitable Institutions Act, 1926, and its amendments being repealed, the Board of Central Otago be afforded some relief in the treatment of T.B. cases coming from the districts of other Boards.” Such was a remit moved by Mr Ritchie on behalf of the Maniototo and Vincent Boards. He said that he had been afraid that section 92 of the Act would be recommended for abolition. His district was a very dry one and T.B. was very pronounced. They received a great many patients from outside districts, and under the special circumstances they contended that they should have some relief, Mr Phillipps (Palmerston North) ’ supported Mr Ritchie, and said that it would be a local disaster to some boards if some relief v as not afforded. Boards so situated would have to approach the Government direct for protection. Mr Quelch (Otago) said that he real- | ised the position of Maniototo and Vincent, who had many people go there '

for health reasons, and there was no doubt that something would have to be done so far as they were concerned. He thought the conference should recommend that they receive special treatment.

Mr Carman (Wellington) said that difficulties would arise as a result of the repeal of Section 92, but they would not be as great as if the section remained. He thought that many boards would feel a moral obligation if not a legal one in special cases, and he suggested reciprocal arrangements where special facilities were provided by smaller boards. The motion was carried. National Health Insurance The Wairarapa Board moved:— (a) “That when the National Health Insurance Scheme is brought into operation the administration be arranged so that the controlling authority be Hospital Boards in their respective districts as now defined.” (b) “That when the National Health Insurance Scheme is brought into operation central control should be vested in the Department of Health.” Mr Thompson moved the remits, and submitted that they drew attention to the important features of any national insurance scheme, which might be introduced. In the British scheme, central control was vested in the Minister of Health and local control in smaller societies. It was contended that in New Zealand, there was already a specialist service operating, and local control might well be vested in hospital boards in the various districts. Without very much disorganisation the scheme could be fitted into the existing machinery.

An amendment was moved by Mr Glover (Wellington) that when the scheme is brought down, a special conference be called by the executive to consider the matter. The amendment was seconded by Mr Quelch (Otago). The president said that it was the intention of the executive to call a special conference. The remits were carried. Hospital Taxation Grey Board submitted the following: “That Conference again take up the matter of hospital taxation with the view to having same altered to a more equitable system.” Mr Smeaton (Grey) said that the remit had previously been before conference, but had been defeated. His district contained a very large and mixed population, comprising coal and gold miners and men engaged in the

milling industry, which were dangerous occupations, and there was a strain on the hospital Board because patients could not pay. The motion was seconded by Mr Wilkinson (Tauranga) who said that his board was obliged to treat a great number of Maoris. He would leave the system of taxation for the Government to formulate. The chairman explained that the matter had been thoroughly discussed, when it was considered that the present system supplemented by the National Health Scheme would be equitable.

Mr Potter (Auckland) considered that there was time enough to consider the matter when the Health Scheme was brought down. Mr Vickers (New Plymouth) expressed the opinion that while the taxation system was not perfect it was a matter for local bodies who had to levy the rates and not the hospital boards. Mr Auld (Inangahua) suggested that a more equitable system similar to the unemployment tax should be devised. Mr Rodman (Waitaki) held the view that taking everything into consideration the present system was not far off the mark. Mr Pryde (Southland) supported Mr Rodman, and said that some of the Boards were fairly well treated in the sliding scale of subsidies. They were wasting time discussing a hoary headed remit. The remit was lost by a large majority. Voluntary Contributions The following remit was presented by the Bay of Islands Board: “That subsidies and bequests on voluntary contributions be restored in cases where such bequests and voluntary contributions are to be expended for hospital maintenance or capital purposes approved by the Department of Health.” Mr Miller (Bay of Islands) explained that when voluntary contributions were abolished in 1931 it was considered that bequests were something of a windfall. He asked for solid support as the abolition of the subsidy had fallen heavily e on ratepayers, especially where there had been community efforts in the past. The remit was seconded by Mr Potter (Auckland) and carried unanimously. Fund for Loans A remit from the Waikato Board was: “That in view of the fact that Hospital Boards are finding it to raise loans for building purposes authorised by the Local Government Loans Board, the Government be asked to provide a fund from which Hospital Boards can borrow at the rate of interest authorised.”

In moving the remit Mr Ryburn said he considered that the time was opportune to press the matter. The remit would be the means of making money available earlier.

The remit was seconded by Mr Morse (Napier) who said that if the Government was prepared to find money for Ute housing schemes to be undertaken by municipalities so also should money be available for hospitals.

The fact that practically every hospital in the Dominion had a building scheme was mentioned by Mr Rodman (Waitaki) who held that Hospital Boards should emphasise their claims.

The remit was carried. A remit from the Cook Board: “That the present practice of nursing staffs addressing patients in hospital by surname be discouraged,” was unanimously adopted. The Mentally Unfit Major Dagger (Nelson) presented the following remit: —“That the Government be asked to amend the law with a view to preventing the physically or mentally unfit from reproducing their kind and so safeguard the general health of the Dominion.” Major Dagger said it was unnecessary to emphasise the cost it was to Hospital Boards. It was difficult to collect accounts from the unfit classes. Although the matter had been discussed by the executive and it was suggested that they wait until an inquiry was held, why wait for another inquiry? There was no evidence of any action being taken in New Zealand and something should be done to build up the health of the nation. He urged that the conference again approach the Government, as he had faith that it would do something. The Rev. C. Wood (Auckland) supported the remit and referred to the very grave evils that could be spread by the unfit. The chairman was of the opinion that as the executive already had the matter in hand, the remit would give them simply the same instructions that were given two years ago. The-remit was carried on a show of hands. “That it be a recommendation to the Government to establish a number of institutions for the care of the mentally unstable members of the com-

munity, not actually certifiable, and that Magistrates be vested with powers to compel such people to enter these institutions,” was a remit from the Waitaki Board. Mr Rodman (Waitaki) explained that the remit aimed at the provision of a half-way house. Dr. Craven (Auckland) said that there was a large gap between the voluntary boarder and one who was certified as insane. It was a very serious responsibility for any medical man to certify a person as insane. The remit was carried unanimously.