HOSPITALS

Wanganui Chronicle, Volume 75, Issue 258, 1 November 1932, Page 10

HOSPITALS

CHANGE IN CONTROL COMMISSION’S REPORT DIVERGENT VIEWS The need for a thorough investigation into hospital administration in New Zealand was urged by the Government member for Wellington Suburbs (Mr. R. A. Wright) in the House of Representatives last week. He referred to the ever-increasing cost of maintaining the hospital system of the Dominion. A contrary view was taken by the Government member for Palmerston (Mr. J. A. Nash), who warmly assailed the findings of the Commis-

Mr. Wright referred in the first place to the enormous increase which had taken place in the cost of hospital administration, and said that the cost per head of the population had jumped from 9s 4d to £1 5s lOd. The portion of the report to which he wished to refer particularly was that which suggested that economies could be effected without impairing the efficiency of the system. The commission pointed out quite correctly that there were far too many small hospitals in New Zealand. At the same time he had no sympathy with those who thought that patients should be discharged earlier or that they should not be received at all. He did not stand for that. It must be obvious that the small hospitals could not have anything like the equipment that the large hospital had. There were at present 45 hospital districts in the Dominion, and the commission recommended that they should be reduced to eighteen. A similar recommendation had been made by the Health Dpartment years ago. Mr. Wright referred to the high cost of maintaining beds in the small hospitals, and urged that the Government should make a thorough investigation of the recommendations of the commission. The main consideration was that the patients should not suffer in any way. Mr. P. Fraser (Labour, Wellington Central): Is there anything new in the report that has not been before the country for years and years? The Need for Battle. Mr. Wright said that that might be ; the case, but in the case of every reform it had been necessary to battle away for years and years. He submitted that there was a case to answer. The Economy Commission had gone thoroughly into the matter, and it was now for the Government to carry out a complete investigation. The Government should endeavour to see whether the statements of the commission were corrct and whether it could give effect to them. Mr. J. A. Nash (Government, Palmerston) vigorously assailed the recommendations of the commission regarding hospital administration. “In New Zealand we have cause to feel proud of our hospitals and their administration,” said Mr. Nash, “and we should jealously guard against any interference that might tend to take away from the people that for which they have worked so earnestly for so many years pas.”

The late Dircetor-General of Health had advocated a reduction in the number of hospitals, but this could not be carried out in the drastic manner suggested by the commission. Mr. Nash described as most unfair the proposal that the honoraria of chairmen of hospital board should be discontinued. Today the work had become full time, and the allowances given for the services performed were inadequate. He did not agree with the commission’s views regarding the length of stay in hospitals, and he regretted deeply that that body should have proposed a further reduction in the “measly pittance” received by the probationers. Probationers performed a wonderful service to humanity, and it was to be sincerely hoped that the Government would utterly disregard the cominis eion’s recommendations under that heading. Mr. Nash defended the present method of purchasing stores as being entirely sound, and characterised as a very retrograde and absurd proposal the suggestion that local bod ies should take a hand in the administration of charitable aid. The only body competent to deal with charitable aid was the hospital board. It was difficult to understand why the commission had advanced the proposals. The Minister of Health (the Hon. J. A. Young): The whole thing would break down. Piling Up Charges. Mr. Nash: Of course it would. We cannot go on piling up the charges on the local bodies. They are carrying quite a sufficient load as it is, when one remembers the amount expended in connection with the relief of unemployment in allowing relief workers to work off their rates and their lighting accounts. Concerning the suggestions for the collection of fees, Mr. Nash said the boards were already doing all that was possible in that direction. If a relief worker who had to go into hospital could not pay, the board took the humanitarian view, and huge sums were being written off annually in that connection.

BOARD’S CRITICISM POINTS OVERLOOKED. A copy of what was described as ‘ ‘ the considered opinion of the executive of the Hospital Boards’ Association” on the Economy Commission’s report so far as it relates to hospitals was brought before the Wellington Hospital Board at its meeting. The executive said that the present system did not facilitate an increase in levies if subsidies were reduced, foi last year and this year reduction in levies and subsidies went hand in hand. Criticism is made by the executive that no mention was made by the commission of the very substantial economies in expenditure which were effected last year. Vital factors which had been ignored by the commission when dealing with expenditure include the trend towards more use of institutional treatment encouraged by improved facili ties, improved medical and surgical skill, and an increased confidence in public hospitals on the part of the public, better provision for T.B. and other chronic cases; decrease in the purchasing power of money; the charitable aid increase from .1914 by the

startling amount of over £200,000 per annum; very considerable increase in motor and industrial accidents and heavy losses in fees occasioned thereby; improved conditions in hours of duty of nurses and their remuneration, also in remuneration of staff generally; inauguration of a superannuation scheme costing an additional £19,000 per year; increase in population of 350,000 persons. Further, the cost of treatment of ex-soldier cases—still an important item—should not be lost sight of when comparing expenditure with those earlier years. Also there should be taken into consideration the post-war economic position necessitating many more receiving hospital treatment through taxation. Sanatoria Charges. The commission did nut appear to have been aware—as it should have been—that all patients in the North Island admitted to sanatoria had the payment of their fees undertaken by hospital board and the fees so paid approximated the cost of maintaining these institutions. Thus the burden fell equally in the North and Soutu Islands. Moreover, the cost of sanatoria in the South Island as administered by hospital boards had been eased by Government grants. Hospital boards had responded to the urge for economy at least as readily as any of the other local bodies. It should be pointed out—as the commission should know —that countries which had relied on voluntary contributions, for example, New South Wales and Victoria, had drifted into great financial difficulty in financing their hospitals and their Governments had had to come to the rescue. Also, the questionable recourse to State lotteries has been made. With regard to the recommendation that the number of hospital districts should be reduced from 45 to 16 or 18, the executive stated that the association at the conference in June had endorsed the principle of amalgamation through a process of mutual agreement and understanding between the hospital boards themselves. At present the subdivision of a district could only be effected by Act of Parliament. Experience showed that the small district was not necessarily expensively admintisered while having a more favourable experience in collection of fees. Nor was the large district the most economical. All that could fairly be said was that, within certain limits, the larger districts tended to facilitate economical administration. “A Paradox.” . “While drawing attention to the present 45 hospital board districts being too. many for the contral of hospital activities, the commissioner later on in the report recommends that charitable aid should be administered by the 313 county councils, borough councils, and town councils. Surely this is a paradox,” comments the executive. “The recommendations of the commission for the setting up of a ‘board of hospitals’ are familiar. Somewhat similar recommendations originated from the New Zealand branch of the British Medical Association in 1926. They arc designed to take over powers at present held by the Minister, the Department of Health, and the hospital boards themselves. The idea was recently developed by Dr. R. Campbell Begg. Jt may be pointed out. that the Hospitals Commission of New South Wales is a non-political body with the power to close hospitals, and has closed none. The Charities Board of Victoria is also non-political with similar power which it has not exercised. In Australia, between the four years 1924 to 1928, the number of hospitals increased by 37, and the number of beds by 1600. The number of in-patients treated increased by 75,000. The inference may therefore be taken that hospitals are not established for political reasons, but to meet the needs of the communities which they serve.”

The commission had commended the New South Wales and the Victorian systems as a precedent, but these were not hospital systems in the proper sense of the word, but merely represented an attempt to co-ordinate the work of numerous independent institutions. The position in both those States was not such as to encourage the adoption of their schemes of hospital finance or administrative machinery. New South Wales desired to obtain a system of hospital finance similar to that of New Zealand, which, by the way, was the only country in the world which had a, fully co-ordinated hospital system with assured finance. It was Interesting to note that under the comparatively recently organised London County Council . Hospitals, 68 per cent, of the patients wore treated as a burden on rates. Careful Consideration Needed. The chairman (Mr. F. Castle) said that any change of policy would need fresh legislation. He thought that consideration of the commission’s recommendations should be deferred. Dr. It. Campbell Begg said that Mi. Wallace, chairman of the Auckland Hospital Board, stated at the last meet ing of that body that he wished to give evidence, but nobody had been given an opportunity of appearing before the commission. Was it within the knowledge of the Wellington Hospital Board that the Hospital Boards’ Association submitted a statement to the commission? Mr. Castle: The commission invited persons to give evidence. The Hos pital Boards’ Association sent a statement to the commission.

Dr. Begg remarked that the position was an extraordinary one. The Wei lington Hospital Board was a member of the association and subscribed to its funds. It was an absurdity to say that no opportunity had been afforde.l to give evidence. He criticised the circular letter which had •been sent to hospital boards. The executive of the association had put the position before the Minister of Health.

The chairman rose to a point of order, and questioned whether Dr. Begg was justified at the present time in criticising the Hospital Boards’ Association.

Dr. Begg moved that a speecial meet ing of the board bo held to considei the question of withdraw from the association.

Mr. C. M. Luke moved that consid oration of the circular of the association bo postponed until the next meet ing of the board. Dr. Begg agreed to Mr. Luke’s sug gestion, and gave notice to move at the next, meeting of the board that the board withdraw from the association. The consideration of the associa tiou’s circular was deferred until next meeting.