Hospital Report

Hawke's Bay Herald-Tribune, Issue 162, 27 July 1937, Page 8

Hospital Report

COMMISSION'S VJEWS Newspaper Comroents on Findings NATIONAL POLICY Further comment which has beeu Kt&de editorially in various New Zeaiand newspapers upon the findinge of ihe. Royal Commission which. inquired into the affairs of the Napier lJublic Hospital is as follows: — tim Waikato Times.—Tho Royal Commission that recently dnvestigated hiattera in connection with the Napier Hospital may have gone a little beyond ita order of reference ip mentioning in its" report issues touchdng the general hospital system, but when read carefully it .Will be found that the stateanent regarding a nationalised system wna most guarded. "There is much %o be said," the report stated, "for the contention -that the hospital system of New Zeaiand should be, in a large measure, nationalised." Hueh has been ®aad, in the past, and there can be no isbjection to the whole subject being ugain discussed, because the finding of a commission, after investigating the sffairs of one institution, cannot be accepted as conclusive regarding national policy. As a xule divided control is jneither efficient nor progressive, and if the Commission thought that there was a line where national and local control eould be fused then it might well have gone §. Ettle forther in its report and stated how this could be effected. Apparently as an alternative to full control, the Commission thought that the Government, having to provide a share of the revenue of the boaxds, should have a representative on those bodies. To many people that would appear to be reaeonable. It has puzzled them why the Government should have 4 nominee on harbour boards, to whose revenue the State makes no direct ccmtribution, and not have one on hospital boards where it does provide a full share of the money. Possibly the alljmportant question of finance was deemed by the Commission to be out•ide the scope of its inquiry, but it, cannot be excluded from any discussion with respect to the hospital system generally. The basic principle that those who provide the money should have a voice in the expenditure applies. If the hospitals were to be removed from local control then the rating system for the upkeep of the institutions also must go. The finance, as well as the control, must be on a national basis. In view of the undertakings of the present Government to institute a national health insurance scheme, and the election pledges to make available a akilled home nursing service, probably the ouestion oi hospital accommodation and the system generally will come under review. If the Commission found that soine of the diiiiculties at Napier were due to district rivalries, it would not be hard to find an instance where central authority had insisted on a hospital being built in a town, despite the fact that there were two fairly large hospitals within twenty-five miles and the boaxd did not regard an additional ama.ll hospital as necessary. It would not be advisable to conclude that any national system would exclude the full use of political iniiuence whenever posaiblfj. . 9 The Taranaki Herald. — The report condemns with no uncertain voice a #tate of affairs that is certainly without precedent in the hisory of modern hospital treatment in New Zeaiand. In fact, it can be stated that the evidence at the inquiry disclosed a situation so disgraceful that it constituted a challenge to-New -Zealanders'' reputation for effitieficy and administrative abi-. lity. The particular aspect of'the report is tjhio question of personal blarae and at this stage and in this place com- ( ment on this aspect would not be proper. The general aspect, kowever, of how far weaknesses in the hospital control system of the Domiuion contributed to the breakdown of discipline, nursing technique and administration at the Napier Hospital is ot such geheral Interest that the conclusions of the commission deserve the fullest public attention. The day-by-day disclosures at the inquiry shocked public opinion aud fcievitably brought the view that there must be some radical weukuess in the method of control to permit sucli a potition. to arise. And when it is realised that the hospitals of the Domiuion eaeh year cost • the Government £870,000 and contributing local bodies £715,000 and that these amounts are increasing steadily it is not surprising that Ihe whole hospital control system ehould be condemned as inefficient aud uneconomical. It is scarcely exaggeration to say that the evidence at tbe.iuquiry and tbe report of the eoiiiiiiission* will do more to briug aboui; rel'onns than years of ugitatiun. A poinler to what rel'orms are likcJy is given by Ihe commission wl;en it states there iov much to be said lur the contention that the hospital system shoultl be nationalised. Few will now oppuse the coiuunsixon's recouunendatioti that stncter departinental control oi boards shuuld b« uudertaken aud that, if retained. "boards shuuld have their powers clearly delincd and slrictJy lnnited. " The conimissiou points out tliat the very extensive and ellicieiit system ul hospitals- under the control of the Loudon County Council is administered without hospital boards and it states that under iudepcudent central coutrol New Zeaiand hospitals could be graded and eo-ordiuated. These and similar rocommendations will be given the closest attention as the Napier disclosures were not necesSary to' convince the public that girave weaknesses exist in the Dominiou's hospital system. Ihe erer-increasing burden on ratepayers and the feeling that local body control is not always the most ecouoinical ha*.e ied to tnucb dissatis-lactiou, Anu when, in addiliou rank inelhcieucy is disclosed, as at Napier, the uupopularity oi j&e whole system is inteusitied. ThrSouthfand Times, invercargill.— The ootnmission has found tliat defects in aupervision and nursing technique— including even insufficient facilities for dismfection— were prime faetors in the epjLaa4 of an inic.ctious. disease, faetors

which "cannot be condoned.l' One oi the children died as the result of being subjected by a member of the honorary staff'to an experimental method -of heat' treatment wliich the* commission describes as "crude, not properly supervised, not" supported' . . . . by any proper records .... unwarranted, and dangerous." The commission's further inquiries revealed other conditions- hardly less alarming. The nurs ing staff at the hospital has been overworked (no one .in authority was even aware of the legislative provision limiting hours of work for unregistered nuises) and inadequately trained. The hospital board was divided into twc rival sectious, representing Napier and Hastings respectively ; and the unrest caused by tbis situation "permeated the whole administration of the hospital throughout its^various branches." Difficulty was created by the fact that the member of tbe honorary staff of whose conduct the commission has inade such an emphatic condemnation was also a member of the board and, as such, resisted his own dismissal from the honorary staff. It is clear that the Napier Hospital has for some time past been in a state of serious disorganlsation and that some such scandal as actually occurred over the outbreak of vulvo-vaginitis was inevitable .... The criticism which the com r mission has made of the Napier Hospital is, to some extent, a criticism of the whole hospital system. The Napier Hospital Board is not the only hospital board that is subject to "political and local pressure" ; the Napier Hospital is not the only hospital where there is division of authority among the medical superintendent, the matron, and the secretary, or where %'nurses aro made to work for excessively long hours. The suggestion is made that the Government, -as the source of half the money for hospital maintenance, should have direct representation on local boards ; but that would be likely to accentuate, rather than prevent, the division of boards into political factions. The appointment by the Government of commissioners — unless they were chosen with a freedom from political prejudice that we hardly have reason to expect — might prove no better. But it seems clear that if the hospital board system is retained the powers of boards will have to be liinited and the powers of the State correspondingly increased — in 'other words, that the hospital system will have to be centralised to a far greater degree than at present. The • commission's recommendation that hospitals should be co-ordinated and graded in order to s'ave money jmd prevent overcrowding in the more expensive institutions, was supported by the National Health Insurance Committee of the British Medical Associotion in a report published earlier in the week. This committee (which, • of course, had no reason to express au opinion on the administrative side oi the hospital system) held that co-ordi-nation could only be acliieved by tbe creation of larger hospital districts, "permitting proper classification of hospitals according to their ability to deal with special varieties of work." Poverty Bay Herald: Although tho Napier Hospital Commission was concerned primarily with investigating specific allegations regarding tho administration of oue particular institution, it felt impelled, in the course of its vaiuable report to make somo general comment on the hospital system of the Dominion. . . . There is a tendency throughout the Dominion to take the hospitals fhr granted, to look upon them as a national service, and to be content to leave their administration to those more directly concerned. There is a proneuess, also, to assume that the system is unrivalled and that the conduct of the institutions is beyond reproach. Occasionally, as in the Napier instance, this complacency and pride receive a rude shock and there is a momentary feeling of uneasiness which gradually disappears, only to be reawakened by au incident of some sort elsewhere. The point that requires consideration is whether the defects discovered at Napier are peculiar to the administration in that centre or whether they are the result of some weakness in the system itself. . . The commission itself raises the point of whether the hospital system in New Zeaiand should be, in a large measure, nationalised. It does not actually recommend such a chauge but goes so far as to remark that "there is much to be said for the contention. " The comment of the commission seems to recognise the differenca and the conflict between what is practicable and desirable and what is politic. . . The danger of political and local pressure and the ill-effects of rivalries and jealousies, referred to in the report, will be freely admitted, but the question is how to provide remedies without resorting to centralisation. The commission contents itself with saying: 4tCertain it is that hospital boards, if retained, should have their powers elearly defined and strietly limited.' ' The paramount difficulty is that a hospital board performs several functions, charitable, humanitarian, aud scientific, and meinbors qualified lo deal wilh one aspcct migkt be totally ignorant of tlio other, . . The difficulties that ariso in counectiou with administratiou are . pparent, also, in ihe election of member^ of hospital boards, for the public is expecled to select mcii competcut to perform three distinct functions, ono of which requires wide pxofessional knowledge, wliile ihe pcrformanco of the others niigh t. be liandicapped by tbc possession of- this knowledge. Anotker probtem arises iu connection with tho financhig of hospitals, the local authoritics, which find balf the funds, having no direct representation on the board and, therefore, no control of the finances which tliey provide. It ia possible that these cieiueutary difficulties wquld bo overcome by an alteration in the procedure for constituting boards. The Government, which subsidies all expenditure, might noininate a certain supqtvision which the commission regordH as uecessary. The other members, instead of being elected, could be appointed, as has previously been advocated in Gisborne, by the local bodies.