THE HOSPITALS

Evening Post, Volume CXIV, Issue 125, 23 November 1932, Page 7

THE HOSPITALS

SYSTEM OF CONTROL

MIXED OPINIONS

FURTHER INQUIRY WANTED

SECOND READING OF BILL

Hospital expenditure and control Was debated to length in the House of Representatives yesterday during the second reading of the Hospitals and Charitable Institutions Amendment Bill, which provides the machinery for the amalgamation of hospital board areas. Although the prin-. ciple of the measure was generally endorsed, the fear was expressed by some speakers that the operation of the Bill might result in a curtailment of hospital facilities for the country districts, and the Labour Party expressed its opposition to any decrease in the expenditure on health services. The Minister of Health (the Hon. J. A. Young) said that the Bill was designed to make further provision for •the amalgamation of small hospital districts. At the present itime an amalgamation could not take place unless by mutnal consent of the boards concerned or by legislation. The Bill brought hospital boards into line with the law relating to counties and municipalities. The Governor-General by Order-in-Council had the power to set up a commission to inquire into any orfe or more of the following questions:—(a) Whether any two or more contiguous hospital districts should be reconstituted so as to form a smaller number of districts; (b) whether the boundaries of the districts should be altered; (c) whether any institution under a hospital district should be closed or whether the forms of Telief granted in or from any such- institution should be restricted; or (d) whether any two or more hospital boards should combine to estab-lish-or maintain any institution. Some of the smaller boards considered that ■they might not have sufficient time to prepare their case, but a commission would not be set up until after mutual arrangements had failed. The time that would elapse before a commission was set up would give the, smaller boards sufficient time to prepare their case. Any Teport by a commission had'to be ratified by the Governor-General in Council, but the Governor-General was not compelled to give effect to the recommendations. The Bill said that he' "may" give effect to them. In the case of a change being brought about, there would be no curtailment of the facilities which had been previously granted. The Bill also laid down that hospital boards were required to provide for maternity cases at the direction of the Director-General of Health. There was great need for this provision owing to the large number of indigent people at the present time, and he was glad to see that the Hospital Boards'. Association acknowledged its duty in ' this direction. The Bill gave the .hospital boards power to recover the cost of treatment from persons who had received special compensation in respect of their injuries. This jflid not apply to workers 1 compensation payments, but :to particular cases where damages had been awarded to cover injuries. REDUCED SERVICES. Mr. M. J. Savage (Labour, Auckland West), dealing with the reduction of hospital districts, said it was desirable that nothing should be done in the ■way of cutting out any services in the interests of alleged economies. He would particularly draw country members' attention to that aspect of the question. He thought he, could see in the Bill a reduction in hosiptal services in city and country. There was 3iot an ample' service in country districts yet. "I would suggest that this is the time when the Government should take some of its own medicine," he said, when referring to the clause providing for tenure of service by,contract. The proposals in Telation to maternity cases would ease the Government of a responsibility which it held to-day. It would shift the cost of maternity services from the Government to the local authorities. That appeared to be a step in the wrong direer tion. "I found undue difficulty in get* ting service for deserving cases because they did not happen to be in the eyes of the board and the law the responsibility of that particular board," said Mr. Savage. "Some day we will have a universal service to which any person in need can apply: whether medical need, or need on the part of indigent persons." The proposal regarding the boards having the first claim on damages, he considered, would apply, to rights under the "Workers' Compensation Act. The Minister said it applied to special 'damages, and not to the Workers' Compensation Act. Mr. Savage said it seemed to give preference ■to hospital boards as creditors at the expense of medical practitioners. While he was anxious that the "boards should be safeguarded, he was anxious that they should not be safeguarded at the expense of others who had equal Tights. A safeguarding clause could be included in the Bill. The Minister: This would not be the Bill in which to include such a clause. Mr. Savage: Will the Minister give kn undertaking that the medical profession will be safeguarded in another Bill?' The Minister: That may be considered. , Mr. .W; E. Parry (Labour, Auckland Central) referred to St. Helens Hospitals, and said he trusted nothing would be done in the way of the Government's responsibility being shifted. Mr. J. Bitehener (Government, Waita'ki) said he hoped nothing would be done which would be detrimental to country districts. Mr. P. Fraser (Labour, Wellington Central) said that ho was in favour of maternity'l wards being established in public hospitals, but he was afraid that the clause in the Bill relating to that would be a double-edged weapon in the liands of the Minister, and would be used to undermine the St. Helens Hospitals. He did not oppose any inquiry, and if it could be shown that certain boards should be amalgamated, he would support it. ON CROSS OF IMFECUNTOSITY. Mr. A. M. Samuel (Government, Thames) suggested that the Bill should be sent to the Health Committee. He took exception to the powers which it was proposed to vest in the Commissions which the Act would establish. Hospital boards in country districts were very much concerned over the provisions of the Bill and were perturbed over the possible results. The sick people should be the last to suffer as a result of the depression, and should Mot be sacrificed on the cross of impecuniosity. The Rev. 'c. Carr (Labour, Timaru) said he hoped every member would lodge his protest against the abrogation of Parliament's job to outside commissions, and he supported Mr. Samuel's request that • the measure should go before a Select Committee. Mr. K. S. Williams (Government, Bay

of Plenty) said that there was a desire at the present time that more people should go into the country, but they would 3iot get settlers for the country districts if they did not have a reasonable chance of medical attention and schooling. Of the two, health came first. The liability to accident in the back country was perhaps bigger than in the town, and limbs wero often lost through lack of medical aid. He hoped that the fullest investigation would be carried out before any definite stops were carried out. Mr. A. E. Jull (Government, Waipawa) said that he was getting a little restive about the appointment of coni-'j missions and boards. Mr. J. O'Brien (Labour, Westland) said that the Bill went further than the National Expenditure Commission's report. It proposed that one man—a magistrate—might be a commission to decide the fate of a hospital board. There were some magistrates who were prone to follow the wishes of the Government. In sawmilling and mining districts especially, it was essential that medical aid should be reasonably close at hand. He considered that the hours of nurses in hospitals should not be more than 48 weekly. NOT FAR ENOUGH. Mr. S. G. Smith (Government, New Plymouth) said that there was provision for the appointment of two persons as well- as a magistrate, to a commission. He did not think that the Bill went far enough. There was a demand throughout the countiy for an easing of public expenditure. If something was not done to co-ordinate the social services, without impairing their efficiency, the country would have to face a difficult situation. In face of, the Vresent position of the unemployed, of the farmers, and of the business community, it was the duty of Parliament to curtail expenditure in keeping within the national income. Mr. A. S. Bichards (Labour, Eoskill) said that economy in health and hospital expenditure was not a real economy in a national sense. Economy was money wisely spent, and it was tertainly wisely spent when it was used to nurse people back to health. The Bill provided for centralisation of control, but such a policy did not mean less expenditure and was often attended by decreased efficiency. There was no clamour for a reduction in the vote of the Agriculture . Department which looked after the stock, and surely the human beings were entitled to the same treatment as stock. Unless it could be proved that hospitals had beds lying idle and nurses and the medical staff had nothing to do, there was no case for the support for the BilL Mr. E. A. Wright (Government, Wellington Suburbs) said he believed that the Bill aimed at improvement in the hospitals system. No Commission would suggest that an injured man should be carried over 250 miles over an indifferent road. If improvement could be brought about by centralisation, then it should be done. It may be arguable how many hospital districts should be extinguished. He thought a reasonable improvement coald be shown by a certain amount of centralisation. If a hospital were closed, care should be taken to see that nobody suffered. A bigger hospital provided experis, while in the - smaller institutions the' medical man was called on to do everything. Mr. E. Semple (Labour, -Wellington East) said he was anxious to protect hospitals- in isolated districts—in mining camps and in places where bushfelling was done. SAME SERVICE: LESS MONEY. Mr. W. A. Veiteh (Government, Wanganui) said that the initial action for any jproposed change came from tho Crown, and not from any commission. It was possible under the provisions ,of the Bill for as good a service as at present to be given for less money. Cases of serious injury and sickness should go to base hospitals at the earliest possible moment, and those hospitals should be equipped and conducted so as to. give the best treatment. - • ■■■.-.

The Leader of the Opposition (Mr. H. E. Holland) said he could see danger in the Bill to hospitals in certain districts. He criticised the proposed hours of work for nurses, and urged that the Bill should go to a Select Committee.

Mr. H. G. Dickie (Government, Patea) said the people of Patea would be strongly opposed to converting their hospital into a casualty clearing station. He hoped that the Committee stage of the Bill would be delayed for at least a week, in order that the different hospital boards would have time to consider the measure. The first concern should be the health of the people. Mr. i\ Jones. (Labour, Dunedin South) said he- believed that the Commissions would bring down the reports which the Government wanted. No one could say that 6d per week per head was too much to spend on expenditure on health.

The Hon. A. D. McLeod (Government, Wairarapa) said the evidence was all against a suggestion -that unemployment had given rise to ill-health in the community. He thought the Bill was going too far in regard to the powers of the Government to issue Orders-in-Council.

Mr. W. E. Barnard (Labour, Napier) said there was definite evidence that the children of the unemployed were uffering from malnutritionr

The Minister, in his reply, said he *rould not say that the number of hospital districts should be reduced. His aim was to bring about efficiency, and he did not agree that economy was the most important feature.

The Bill was read a second time,