HOSPITAL SERVICE

Dominion, Volume 13, Issue 212, 2 June 1920, Page 8

HOSPITAL SERVICE

' DEMAND FOR IMPROVEMENT _____ CONFERENCE OF BOARDS MINISTER REVIEWS THE SITUATION Matters of importance to the health of the Dominion wore discussed at a' conference of hospital board representatives which commenced its deliberations yesterday in the Dominion Farmers' Institute's buildings. Sir James Wilson (Palrnerston North Board) presided over an attendance of nearly one- hundred dolegates from nil parts of tho Dominion. The Minister of Public Health (tho Hon. 0. J. Parr) was present at the outset, and delivered an address traversing manv aspects of hospital administration. Dr. T. H. A. Valintine (tho In-spector-General of Hospitals), Dr. Frengley (tho Depnty-Inspector-General), and Mr. A. S. Killlck (secretary to Hie Department) were in attendance throughout the proceedings. Minister's Address. The Minister stated that he had accepted the portfolio of Public Health with some diffidence, as he was aware that the task would not be an .enviable one. Ho advocated some form of compensation'for the public-spirited men who Rave so much of their time without compensation in the interests of public health. He was well aware that many of those who Rave their services so freely did not expect or desire any compensation, but there were others who were not in the same position. the time had therefore arrived when the State should consider somo form of compensation to recompense the recipients for their great loss of valuable time and the personal inconvenience they suuered. The Minister observed that the war had served to intensify tho humanitarian instincts. These instincts could not be denied, and they found expression-to particularise one channel—in the growins demand for better,, and more extensive hospital facilities.

Importance' of Base Hospitals. Alluding to the Temits before the conference, the Minister uttered a word of warning with regard to the claims of country districts for better facilities. In considering these claims, nothing should bo done to weaken the larger lnstitu-tibns-the base hospitals Nothing should be done which would tend to undermine the policy pf strengthening medically and surgically the main 'hospitals of the Dominion. He strongly favoured the creation throughout the country of small maternity hospitals.in charge of a mirse-midwife. Provision should also be made at these institutions for first-aid treatment for cases before their transmission to the base hospitals, . Something like this would to a tarce extent meet tho demands of the country districts for improved facihties. Another point to which he referred was the feeling among boards that such diseases as tuberculosis should be handed over entirely to the State. He was, however, unable to countenance this view. He agreed with the boards that the Bchedlilo of subsidies should be revised. He himself found considerable difficulty in following the schedule, both as a Minister of the Crown and a lawyer. He did not favour a flat rate. This would benefit the. wealthy districts at the expense of the poorer districts. (Hear, hear.) Their "Natural Enemy,"

Tho delegates were addressed also by Dr. Valintine, who said he was of opinion that the conference was eomewnat premature, as the /xmntry was in a rather unsettled stage. We had hardly yet had time to realise the tremendous developments in surgery and medicine as a Tesult of the wyir, and, therefore not able to appreciate the full extent to which such experience might modify efforts in tho direction of hospital and medical services. The present New Z<!aland- hospital system had been_ adopted with some slight modifications.in rfouth 'Sfrica. and he understood it was to be adopted by one or more of the States of the Australian Commonwealth. lSevertheless, he realised that our hospital system had many defects, and these were largely due to misunderstanding which existed between the hospital boards and the central Department. For some reason or other there were some boards who regarded the central Department as their natural enemy, and rendered tho Department' nnwerless bv nnssive resistance. In effect, one of the best hospital systems in the world was spoilt to a large oxtent by misunderstanding and parochialism. Either the boards would have to work more in conjunction with the Department, or the Department would have to have more control. The Department was .directly responsible for. one-half of the Dominions hospital requirements, and yet it had practically no power in regard to appointments, and very little power in the general administration of the hospitals. In eulogising

the work of boards in developing tho base hospitals, Dr. Valintine said that these institutions could ho most favourably compared with the hospitals of the United Kingdom and other parts of Hie world. Country Districts Neglected. Though the 1 hoards had done. exceedingly well as regards the base hospitals, they had to n large extent lost sight of tho.needs of tho country settlers, and the outcry from the country contributory authorities at the increased cost of hospital expenditure, was, under tho circumstances, not to' bo wondered at. The thoughts of the. boards had been too much centred on the walls of their large hospitals. By tho. establishment of a small maternity hosnital here, and tho appointment of. a district nurse there, much of- this discontent mieht have been allavnd. He maintained, therefore, that the Department should have more power, especially in regard to the nppointment of the chief persons on the medical and nursing staff. If, as the Minister had already stated, the medical and nursing staffs were officers of the Department— though seconded for duty with hospital boards—it would make for-a very much better and more _ eflicont medical and nursing staff service than was possiblo under the present conditions. ■

The Inspector-General mentioned that tho Eoval Commission in connection with the recent epidemic had made certain cogent suggestions with regard to the administration of public health, and'it was therefore possible that the Department would take out of the hands of hospital boards all responsibility in connection with the administration of public health. This, to his mind, was rather to be regretted. Touching on the maintenance fees chnrgenble at tho public hospitals, Dr. Valintine pointed out that these were far too low, and he had constantly reiterated that the fee should be not lees than ,£3 3s. per week. It was the duty of hosmtal boards to ascertain what fees each patient was able to pay, and to render him an account accordingly. If a patient was not financially able to pay the full or even part of tho maintenance fee, he

should not. be worried. Ho was opposed to tho opinion of some boards -that such diseases as tuberculosis and venereal complaints should be treated rather by tiie State than by the boards themselves. Chairmen's Remuneration. Some discussion, ensued when the Kninara Board tabled the following remit: "That some provisiou should be made in the Act to meet the expenses of the chairmen of hospital boards incurred in visiting the various institutions under the control of the boards, and that provision bo made for the payment of an honorarium to chairmen."

Instances were given whero some chairmen had to travel forty miles and over in order to visit the various institutions in their district. The Department, it was mentioned, was in favour of the proposal. The remit was adopted, and a further resolution, was earned recommending that the honorarium to be paid to chnirinon bo limited to A proposal to fix tho maximum nt .£2OO was rejected, .as/i Was also the following remit: "That a "uniform flat rate payment, of >E1 la. per meeting be paid to members as travellh'ie expenses, irrespective of distance in eirNi case." ■ Levies and Subsidies. The system of levies and subsidies was discussed at considerable length, many

remits being submitted on the subject. ■ The present system of levying on land vnhies was held to bo inequitable. The flat Tate- was discussed, as wis also the proportion scheme proposed by the Department and outlined in the Journal of Public Health for April. The opponents of the proportion scheme were generally those boards likely to suffer in the nmount of subsidy given by the Department on levies, and conversely the supporters of the scheme were tho representatives of those boards likely, to benefit. The flat rate was condemned by the Departmental officers. Ultimately tho whole matter was, on tho susgeslion of Dr. Valintine, referred to a committee of seven to confer with the Departmental officers, and to report to tho conference. The conference will sit again to-day.