The Commission's Report

Hawke's Bay Herald-Tribune, Issue 160, 24 July 1937, Page 6

The Commission's Report

EDITORIAL VIEWS - I 1 Comment by New Zealand Newspapers EVIDENCE OF INTEREST Eyidence of the interest which ha s heen taken ' throughout New zealand ain the findlngs of the ' Jttoyai uonmussion which investiSated the affairs of the Napier Hos- . pital ia to he found in the editor- * ' lal comment which has heen made • in numerous newspapers. The toitoi tng are extracta from some of the newspapers' comments: — the n.z. ht.kald, Auckland. — "New Zealanders have on occasion 1>een assured that they possesa the hest hospital system in the world. Any complacency they might feel, however, will be xudely snaken "by the findings of the Napier Hospital Commission. No doubt the case of Napieris an aggrayated and deeply shocking oue, but it has occurred in the much-vaunted New Zealand system. The defects that bave developed in exaggerated form at Napier are known. moreover, to exist in other hospitals. . . . It is clear that the system is far from perfect and requires a thorough overhauL Although all the shortooming discovered at Napier wonld probably be found in no other hospital, some are applicable to most institutions. The district jealcudes may not he so pronounced elsewhere, 'but are by no means absent. t. , . Those citizens who have followed hospital administration in their own centres must also sometimes have detected looseness in organisation, slaekaess in control, failure to allocate authority and xesponsibility clearly, inadequate provision oi planning of

buildings and equipment, lack of staff eo-ordination and sometimes underetaffing, and a financial policy that mixes parsimony with lavislmess. Napier 's case is but a glaring example of fairly general experience in New Zealand 's hospital administration. . In putting forward the idea of control by commissioners responsible to thet Minister of Health, it reveals theforce of its xecoil from the board system as erposed at Napier. It has turned from local control to extreme centralisation. Waelher public opinion would approve sucn a complete . change, and whether it would be wise, are extremely doubttui questions. In any case the commission goes no further than to assert * there is much to be said for tho contention.' At the same time it envisages the xetention of the hospital boards and, if they aro retained, says definitely that they 'sliould have their powers strictly defined and strictly iimited.' This recommendation comes much nearer to practical politics than nationalisation and, if adopted and fmtlifully carried ont, should go far toward effecting the nceded reforms." THE PEESS, Christchurch. — Tlie report of the Boyal Commission appointed to inquire into the administration of the Napier Public Hospital and into the conduct of certain persons conoected with the hospital is so alarming that the Government should consider the findings without' delay and announce what action it proposes to take on the basis of those findings. To some extent, no doubt, the scandals which tho commission uncovered were the result of exceptional personal and local faetors. But it ie also true that in a large measure they were made possible by administrative weaknesses which oceur, or can ocenr, in any hospital district. . . . Indeed, now that public opinion is thoroughly aroused, the time seems opportune for a thorough overhaul of the whole hospital system, which has been under a heavy fire of Criticism for several years. The central question is whether the hospital gervice ought to be controlled and partly financed on a local basis. . . . The case for a centralised hospital system can be argued from several standpoints. In the first place, hospital administration involves so many lechnical probJems that it is doubtful whether control of hospitals by ad hoc elective authorities is ever Ukely to be suceessfol. . . . Local control is an obatacle to greater specialisation in hospital work,* the desirability of whicli has been emphaslsed repeatedly by tho Health Department itself and by competent outside critics. There is a continual tendency, under the present system, for hospitals in the smaller centres to be unnecessarily magnified in status and to attempt work which would be better done at hospitals in the four main centres. The hospital rate, which is * nocessary ineident of local control, is a complicating factor in local body finance. Connty councils complain, and with some justification, that their efforts to relate their expediture to tho rateable capacity of their districts aro thwarted by the obligation to levy a hospital rate over which they have no eontroL All these arguments will be greatly strengthcned if, as seems iikely^ the Government greatly enlarges the scope of Ihe national health service. Whether or not the Government will have sufficient courage- to sweep aside the whole machinery of local control, assuming that it regards such a step as desirable, is perhaps duobtful. The progress of Mr Parry's local government reform proposals seems to show that this Government, lilte its predecessors, regards a frontal attack on the vested interests of local bodies as pqliticaJly inexpedient. . . There are two other recommendationa in the commission 's report which, though they do not bear on the question of local versus central control ,are neverthcless oi the greatest importanee. One is the statement that- "the honorary staff generally should be transformed into a parfc-time part-paid visiting staff," since "hospital practice and private practice are interrelated and complemssntary in any community." It would seem that the commission's recommendation arose out of its view that in any fiespital full control and responsibility should be vested in the medical superintendent. If this View can be acsound, ^hen |jt is oasy to geo i

the objecti-ons to honorary stafflng. The other recommendation is that a member of a hospital board should not be allowed to act as coroner in an inquest on the death of a hospital patient. In considering this recommendation the Government might also consider the advisability of a general oVerhanl of tho method of conducting inquests. Wherever possible inquests should be conducted by stipendiary magistrates; if no stipendiary magistrate is available, the coroner should be either a lawyer or a medical man. Th« Auckland Star. "Since the earthquake of 1931 Hawlte's Bay has had no shock equal to that it received during the hearing of evidence at the inquiry into the conduct of the Napier Hospital. . . The partieular set of circumstances which surrounded the happenings at Napier was strange, and hardly likely to be repeated, or to be matched elsewhere. The controlling board, because of inter-district rivalry, seems to have been peculiarly ineffectual. . . As to the apportionment of blame for the partieular and grave irregularities which were disclosed, the public will not be disposed to challenge the findings of the Commission, which was exceptionally experienced, but the public (and not only in Napier) will ask, 'How could these happenings have been prevented?' The Commission has commented eeverely on the actions of Dr. J. Allen Berry, and the layman will think these comments justified by the evidence. But the further conclu- - sion seems justified that under a strong board there would have been no irregularities grave enough to justify a public investig,ation. . . Probably in view of the disclosed conditions in Napier, and the proved ineptitude of the existing board, at least a teinporary period of oominissioner rule is necessary^there, and Napier people, having experienced such rule in municipal affairs after the earthquake, will not be averse to it. But the case for complete nationalisation cannot be regarded as established by the happenings of one district in circumstances which are unlikely to recur. There is much more eo be said for the Commission's other (and apparently, alternative) suggestion, that the Government should have direct representation on Hospital Boards."Evening POst, Wellington. — On the main part of the Napier Hospital Commission's report it is unnecessary for us to comment. The Com.mission found conditions open to condemnation, and has expressed that condemnation seeerely without fear or favour. In doing so it has dischargied faithfully an unpleasant but necessary public duty. There are, however, certain comments upon the general hospital system which call for puolic consider ation when the Government is about to institute a scheme of national health insurance. One of the poiiAs made in the report of the New Zealand Branch of the British Medical Association was that hospital reorganisation was an essenfcial part of an efiieient national health service. The observations of the Napier Hospital Commission, made independently, support that statement. The Commission, indeed, goes further and suggests consid^ration of hospital nationalisation, with . commissioner control to secure proper grading and coordina(ien of institutions and avoid the ill-effects of local rivalries and jealousiea. A centrally-organised system of district nursing and an organised medical service are also advised, so thai persons who can be satisfactorily and cheaply treated in their own homes wiJl not add to the pressure of hospital acoommodation. These comr ments of- tbe association and the .Commission serve to emphasise the need for adequate^preparation in the introduction Of a health insurance plan. If a scheme based upon the hospitals is introdueed before the hospitals are ready there will be great difficulty in subsequently making the necessary correction; Daily Telegraph, Napier — Thq editorial says that "the commission has not matched the -thoroughness of its examination with corresponding thoroughness in its findings." The report, in its treatment of staffing problems, and other relatively minor matters is considered to be valuable, but "in its treatment of the broader and more important principles involred it is singfularly barren." The report is "weak and indecisive, at fault not so much in what it says as in what it leaves unsaid. It is largely a survey of the evidence rather than a vigorous corrective report. It is not the workmanlike, imaginative and helpful d.ocument which had been expected, and it must arouse a deep and acute disappointment. The outcome of the inquiry is a blunt frustration of those hopes so promptly raised and so widely strengthened when the commission was appointed."