THE SICK AND NEEDY.

Dominion, Volume 3, Issue 716, 15 January 1910, Page 6

THE SICK AND NEEDY.

HOSPITALS AND CHARITABLE AID. ■ ;'- EECENT LEGISLATION; ADDRESS BT-.THE HON. G. FOWLDS.: '.(By .Tele(rraph.-|Presa Association.)"-.:', New Plymouth, January 14. , The Hon. .Geo. Fowlds, Minister/in charge of the Hospitals and Charitable Aid, Department, in response to. an vitation from tho local bodies conoernedj, delivered/an address in! the Town.'Hall: to members, of local bodies', contributing: to the.maintenance..of'the hospitals: in Taranabi. ; -,The,Minister': dealt- in! detail' with the• hospital legislation passed 'during last session; and hospital adininistra- , lion generally. After thanking-the peb--pie of the district; for affording him., an opportunity: to- address' them' with.regard to the purposes and scope.'of! the' new Hospitals ' and''Charitable -Institutions Act, he reriowed;,thp. trend' of.'"social' thought and • developinent in medicine and surgery that had, marked tho past, three decades, and said 'that/in.''.'framing the present ,'Aot all these 'matters had- been borne in niind. ' Notohlv;was'.provision made for,.the care, of, .helpless- sick andneedy in .various institutions;.'but,, also for... their, care an.d'.treatment,' thronghout, the Dominion.. ■ It; was; hoped also'-that there .'was-sufficient elasticity' 'in." the- law to allow public arid 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-larger cities; ■-'~: ! Concerning' the Bill,- itself, he said he would deal.,with its main principles! The Dominion was divided into 36 hospital 1 districts'. /He,had' hoped it would have been possible to- provide larger:.hospital districts, for 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' that "of a', smaller district, ; and be/selfcontairied:: as' regards:, the institutions necessary, namely— ; . ..■-...'.. ': (1) Thevbase .'or .main-hospital.' ../"' : (2):Subidiary''and: cottage hospitals.--'i-! ' / (3):lnfcctions .diseases. :ho'spitalj - , ■ > .. (4).C6nsuriiptiye' sanatorium ! 'ot. annexe.--(5) Old.:people's hdirie." .;''.-' /"■.'..' '..'.'.'■!• . (6) Chronic ward./. ."-'"'-. ■ : (7) Maternity hospital "or /ward.', ;;■'■•'. •', , ■ Vast .'Responsibilities.,!' ' ;,•' ; 'It . . was -' quite.';beyond .'-.. the ; , means, of smaller hospital districts -to' undertakesuch; vast responsibilities, but to a great extent this -could, be/obviated by ;Section G6 : of the .Act,.- which;.!ehablecf two;.'or. 'more.'-.Hospital - districts.;',to : -. combine -! for !the .purpose, of '.orectirig and mairitaining institutions: common' .to ■ the'; combined districts. " For example, "it .-would be/absuij'd for the: Stratford or' Hawera tboard to. each ..undertake ,'the.. rrapphsibilityUbf, erecting an/old':meh's!horiie, or-consump-tive annexe,. and ~he,. congratulated!, these. boards on-- having ■•■■ decided .to' combine with' .-Taranaki (Board'-..for tho'.:purpose: of ,-niaintaining -a' consumptive, annexe, old-..people's ; f nome,;...-and:,-chronic ,'ward I to be .attached '.to the: latter.' ,Tho bther : argument ;ih/favour, of-,largo.•'.dis-tricts ': was , the;- f act . that -'• the • burden • of poor relief was, so'-- unevenly distributed;' :Under the! now law all 'thev.boards.'had "control: of/.-charitable"aicLrjas'^wcll,"as I hospitals,'and .kindred ,institutions.:-.. In rsomo'.'parta' of the. Dbminiori;'.'/charitable aid and -hospitals hadbeeri'' administered I'by separate- boards,:,.and ;this.; often led rto - confusion, and disputes;!. Happily,", with; tho' exception; of: cortain^institutions.to bo supported.. - iridependontly,, ;,of' "separate.-,'institutions?' ,'werb.','■'now;: abol-. 'ished, and'with ttem.'disappeared'.'ono'of : the.:worst anomalies;of: the,.old-'law; "All matters ..affecting the helpless'!':. sick : and. needy ;being ; under,-, the! control ! i'of.!. one" board; tho!.; latter'/could' decide .where '.to, send, their acutely 'sick';, their chronic' and incurable cases, their''consumptives, etc.; and decide what; patients '•• should !:• be treated in..their. and .what patients', should: be/treated'' at their/own homes by:various agencies that'thei'-bbard-nnder the nelv'.Act bad power'to invoke. ,; 1 ' Under _Section: 61 tho board'wasjenabled to .'appoint;' committees,. including persons who-were! not metabfirsof/the board. This was - one-W?the/most- important section,'for by'its means'the:board' would be-able/to call .to its aid persons-having; ,special.experience in;various,social'matterafor which .the board was directly or indirectly-responsible .under.:'tho r - law; whether! as'a member.of the.boardi-o'r oojnuiittee,ior whether• as'a'nurse-or- district No scheme:for the prevention or - relief ,of . sickness ;or ' distress ■ could be regarded as. complete whichdid' not ■ 'give: •' the. fullest, 'scope. to. ■ those '■',wellrecognised,' but ".indefinable : 'J attributes. \vith which iwbman,, and' woman.-'; alone, .was endowed.•'-. -/- ;•-.•;..,'.:- -:-:":/ ■; • -';,;'"!■!'/; -:VTh'«/ Health ;Aot. ; "./Iv''^.'-;' ; " Another -very! .important section-;.was 83,,; whereby. a: local body, could.waive: its' responsibilities, • under! the Health Act, to the Hospitak'Board: of-the: district.;,, It' must be allowed that the Hospital' Board: Vhioh .--was: responsible ':for,-.:the"care. and treatment.of the'sick! of .the! district,, and' had,; therefore; tto . bear; a' large, share: of. the: .expense .of .'should:- aisohave some cpntrol; of .the influences.^hicli'• -were: likely , ; tb cause'sickness.'' 'No' sys-, ".tern! of: hospital rreatmerit- should be- di- : yorced from, the.-; system , of -domiciliary.: inspection. - - ..He - hoped that many '•; of ': tho country .local, authorities 'would- take; advantage;..of this, section.•■';. Under-;pre-'-sent circumstances, .partly because 'of "the! number Tand :smalln'ess., of '•!.( the, ,'many!' local •; .bodies',;'.!.; aiid.-.,i i their '/cdnsequeht. want of'-, f Unds, * it; was'next' dd'of; '-.to im-; possible.: to■■ bring:,abbut, that .'uniformity' in icombating /that:- was/so tialif.atta'ck'.were'to bo effectual:!. What: could' the;,smaller :rpads: boards:do iri'i'themattcr? ;'„• ':;/.,-:;:,'.,-; '■!;" '',;'V ;";''.vv;j

Thb'Minister cobimdnded'the.combining .of 'local 'authorities':tb•'.pay/;the..'salary of a: sanitary inspector,-and : 'advised that, appointment..'should,; bo'',iriado,' ; by. Ahe' . hospital; board,'andV as-for'.this; experidi- : I'.ture, '.thb.'-Goyernmbnt'i'paid:■ a.;.£ 'for, £ subsidy. ■;;local:'authorities, .would' save, ■ monej' by.i'. the'.;-.transa'ction... .-".-Siriitary' , inspectors...when .under;.; the •'. .control.(of;' boards, would; also, perform; .inspectors..of:charitable.relief, and;report, upon' circumstances.:.'surrounding, .applK cants, for '.charitable relief, -possibly gavinglnuch abuse of'' chai'itablo.', aid.! is ,i'-,a' covollaTy.tb'.the, board'assuming Tespbrisi-' bilities ~of local authority .under ;the' "Health Act,,■the;,'hospital,'surgeon would naturally be expected to "give, advice; to . the board arid' Department- of those influences affecting ! the, health - of, the district, and, the .'inspector ■ would', be ; guided' by his advice and directions.... Midwifery Training. ; The; maternity.,patient, and- 1 , her. infant;' 'had hitherto;, been .considered .outside responsibilities. ,of,. hospital .In most countries whero the decline in the birth-rate had ■■' become apparent, it; - had. been recognised as imperative for: the -State to counteract: this tendency.. The late Mr;'' Seddon - recognised -this,*, and ■with the.intuition- of- a great, statesman' caused to .'be .'established-. in '. the. larger contres' matorniity' homes,' known,.as« St. Helens' Hospitals. • These' 'institutions wero not;.only' provided with the. best possible. treatment"for: some 1000' mothers every 'year,: but also for:;,the training'.of -some' 50 ' midwives yearly. ' The Dopaftment was endeavouring, to get trained women;.to - practise in these disi tricts,"'but 'of the"l2o 'midwives/'turned' but'from'St. Helens only,a'small'number' : were.-iii?.prabtjeb'in,,these' districts. But: , 'of 125 turned .out' from St. Helens,' .'only', '. a small: number .were known : ,tp /.be i practising ' in the:"• backblooks'/.districts.'' They -must..try to ; conritoTact;this ten--. dericy : '.byV ■■ increasing*' '.tho;/. ,output of ■'.-.: midwives, ,:'and' ''by .'giving./' special . encouragoinent '.to ./country., girls .';,to> coriie' in -, for. training :,and ; 'go 'back .to 'thoir--districts':to; practise.;!'.-In' addition• to,/ increasing..-. the',' 'accommodation -for! prou'ationbisvat, .St; .Helens.; and .other' ' maternity;-'homes..',they; 'should':,provide maternity' .wards :,at /country 'hospitals. 'To, obtain.the 'training,necessary for. a midwifery certificate, -ffie expenditure'_of : 'somo : J;25/was, involved.;. With;a..'.view of encouraging, country; girls ;to': como in' lor'training, and' go back to; : their' dis^' . diets,; the'Departmont;,proposed. -'.to al-'I :low' such girls to .obtain; their: training I ; free of cost, .provided;;thcy were specf-' ' ally rocarinncnacd.as. suitable .persons "by. '.' hospital ..boards,; and. they, guaranteed. to J : practiso in any..,part of. their'ho'spital . district,to which they'.might bo.sent.for at'least two. years.-. Thiswas, an exp'eri- ■ monf. that,was. well''worth .trying.,. To ' encourage,'midwives to send for:.'medical:, ■'. assistance iri .difficult. cases, as;, was in- 1 cumberit on:, them' under the "regulations Jjof tha Midwives:Act,' the-hospital;boards^

should, guarantee , the expenses of the doctor, eenfc at. a stated fee : for .'attendance, and mileage could be arranged, and in the event of the husband being in a position to pay, the board could rocover the fees':m. the same,' manner as fees were recovered for hospital maintenance. ,'■■ As regards .infants-' it was hoped that, the system; of district" nursing would embody, the excellent work hitherto, only undertaken, by. the-nurs-ing system initiated. by Lord :Pluhk'et. Departmental Control, -;..,'', :-He- thought' that -all,who;ha'd an intimate: knowledge of, the hospital i system 'would admit that- a modicum of Departmental control: was necessary,' particularly 'jn' regard 'to' 'appointments to institutions • and,-limiting, -unnecessary expenditure . The, Department was very anxious, for .the. boards'-'to''adopt --'a uniform system-of keeping accounts as recommended, by, the recent hospitals' "con.ference- in the United Kingdom; " ." .'■ ; ',:'! ■- Cost of' Relief.' ;-.'.'. : As_ set" out in. the old Act the cost of relief-, granted, by.the; board constituted a debt, and- could be recovered by action. Iho.new law,- however,, was- more definite as to fixing responsibility, with regard-to maintenance fees, finance} and 'property of boards.' With the .exception'- of an alteration .in the mode - of'.Government subsidy, 'thero was little .alteration- from-Ihe-.old law as regards' the financial powers of, the , boards.! which considered.itself aggrieved'by the contribution, demanded by , the hospital board, could-still, appeal'for •'an: inqui-ry, to_be hold by'a- commissioner .to-be appointed by tho Minister, ,but the latter was hot bound to. give effect' to the' recommendation ' mode.'- ;The! boards .mighc take land under, the-Publio Works. Act. -:. ; '..:; •!'' , Mr. .Towlds: put forward the ifdllowjrig suggestions" as; the..-best means- of bringing 'the Act.into, operation-.—.'••".'• ■j (I). The amalgamated .'Departments - of Hospitals,' Charitable .Aid,,-and-. Public. .Health to be the central- authority, and the ; duties of its officers to- ho.extended to meet.the-increased responsibilities.. .' , (2) It- was' hoped that; the new system : of election'would-bring:to-the' front members of ,the',old boards,- who had, devoted; much 'time and thought to the -various 'problems .with which they had. been confronted. '■ (3 In addition, to tho, above it- was hoped that/the,boards, would, appoint to com-mittees'persdns-of both', sexes who had shown .capabilities ; . in- the direction ■ and control of private' philanthropic,effort.-. , '■:<(i) It. was in- the' highest -degree, desirable that -where,-.possible, ./the,..hospital boards -should assume.'the powers, or at. any; rate some-of-the powers, of the.local authority; under the (Public Health Act. ! '' ■! (s).Eadh board; 'especially;!.;-those ,;in large,: ..centres;", should. ; set-!, up ;■ three special..; coinmitfess:—(a)'- Institutional: .Committee,.-. (b) -Committee";of • Sooial .Welfare,"and, (c), Committee: of Public Health. .': :Tho .following: pfficers.. would.-, be, required', to Scarry out theivarious! duties of .the':hoard' and its: branches ' ■'~--, .". > /Medical officers: 'The number appointed .being: aocbrdirig to'the requiremohts of the district.. : A definite! fee and mileage should be arranged for medical.,men' attending indigent, cases/ or on : tho'; requisition' of midwjves to' attend cases '.under the, midwives'! regulations.'' ■:::•'- ?• ■:■ > ;''-.■■ '•' '{';■■' ' Inspectors:'. These: should;be..regarded, ■'as/'handy men," and .should combine the 'duties of-sanifaur'. inspector; arid poor 'law officer;"/':,.■':■",;-,'.';.';, •/-•' !■ :; ;- \/-: ■- : ;District riuTses:. Itimay'be necessary! :, to makemore'thanoneVappointinent in some distriet'ihospitals.. • ...In fact,;'] it hoped .that;their:salaries will.be'mostly recoverea.from the-, better-tordo,.who: may'avail themsblv.es''of,'-thei'r;services!' ; -"! ;: i ;..':. ' -Mr." Fowlds' congratulated- the Taranaki ;Board on ..being the firet. 10-appoint a-;dis-..trict hurso; ■' It ..was; not. necessary,; and possibly- would not be'.'wise, ■the!' appointmentß; - that ;• he: had suggested .straight/away, but-there was'no'new-law that' some had ■so .strenuously; fought for. l v at.. them appoint. their. best. men,' bring it--into being,-; and-let--them, administerit with- ..honesty, and-'vigour. He.hadlittlo fear; of the: result if the : people! of' the! Dominion' would'. sustain the' interest-now.shown in the institutions and keep' ever before!them sympathy for the: unfortunate,' '.based; on .the .soundest ! 'di6tates'"df heart':and;common' sense'.'-,