HOSPITAL CONTROL

New Zealand Times, Volume XLVI, Issue 10605, 2 June 1920, Page 2

HOSPITAL CONTROL

BOARDS AMD DEPARTMENT A PLEA FOR GREATER CO-OP-ERATION. ■ ADDRESS BY DR VALINTINE. Speaking at the annual conference of hospital boards yesterday, Dr'T. H. A. Valintiino, Inspector-General of Hospitals, said that the time was not opportune for tho holding of a conference owing to the fact that the world was in an unsettled state, and tho time was not advantageous for hospital development. They had not yet had tunc to realise the tremendous developments in surgery and medicine as a result of the war, and therefore were not able to appreciate to tho full extent how such experience may modify the department's efforts ns regards hospital and medical service ventures. As an instance, Sir W. P. Herringhain, senior consulting physician to the Expeditionary Forces in Franco, had stated that ho had learned morCamedicine in the last five years than in any similar period in his lifo. DOMINION SYSTEM EULOGISED. As the initiator of tho Act which governs .tho hospital system, he had watched its workings with great interest, and it was with pleasure and pride to be told by tho authorities at Whitehall, tho centre of the local governing boards of England, that in tho opinion of experts, especially appointed to inquire into tho hospital system suitable for England and Wales, that of all the hospital systems inquired into within the Empire, and without, tho best <iu<l most adaptable for the United Kingdom was the hospital system of New Zealand. The New Zealand system had been adopted, with some slight modifications, in South Africa, and was, he understood, to be adopted by one or more of the. States of the Australian Commonwealth. HOW SYSTEM IS SPOILT. Dr Valintine said that he realised that there were defects, which were largely due to the misunderstanding which" existe between the hospital boards and the central department. For some reason or another there were some hospital boards'who regarded tbo central department as their natural enemy, and though not active in their objections to any suggestions emanating from the department, yet render the department powerless by passive resistance. In effect, New Zealand had one of the best hospital systems in tho world, spoilt, to a large extent, by misunderstanding and parochialism. If the hospital boards of the Dominion had always worked in conjunction with the department, as in the North Canterbury Hospital Board and one or two other boards had done, the department would have been able to have achieved a great deal more than it had. He could not understand why a hospital board oi local authority looked upon tho central department as its avowed antagonist, iind ho knew of no department which was more dependent 'upon a harmonious working with its local bodies than the department of which he had the honour to he the head.

It simply meant 'that •._ either the boards must work more in conjunction with the department, or the department must have more central control. The department was directly responsible for practically one-hnlf of the Dominion hospital requirements, and yet it had practically no power as regards appointments, and very little as regardi? the general administration. A FAVOURAOBLE COiMPARISON.

As regards the development of the base hospitals, he hud in justice to give tho hospital boards generally very great praise. The to was no* doubt that tho base hospitals could be. most favourably compared with the hospitals in the United Kingdom Mid other parts of the world. Ho had como back from a rewmt trip to the Old Country, Canada and the States of America, and other phtcos very much impressed with the fact that the New Zealand hospitals, to say nothing of the system, compare very favourably .with hospitals in other countries, and ho regarded it as a pity that on acoucnt of the want of co-opera-tion and a better understnding between tho department an d the boards more could not be claimed. NEEDS OF THE COUNTRY DISTRICTS.

Though the hospital boards had done exceedingly well as. regards the base hospitals, they had, ; to a large extent, lost sight of the needs of the country settlers, and tho outcry from the country contributory authorities at the increased cost of hospital expenditure was, 'Under theso circumstances, not to bo wondered at. Tho eyes of tho boards had been too much centred on the walls of their largo hospitals. By tho establishment of small maternity hospitals, ahl the appointment of district nurses, much of the discontent might have been allayed. The department should have moro power, especially as regards the appointment of the chief persons on the medical and nursing staff. If tho medical and nursing staff were otlicore of tho department, though socondod lor duty with hospital boards, it would make for a very much better and more ellicieht medical and nursing s ervicc than was possible under tho present conditions. The department could attract to its service, and retain, the very best medical men and nurses in the Dominion: hut this was only possible where there was absolute co-operation between tho hospital boards and the department, and that was impossible unless the central department had moro power. He could inj. agine that serious objection would be taken to his suggestion; but ,novcrthe!|ss, from his present knowledge of those present, he felt sure that they would sooner have his candid opinion than if he had expressed himself moro diplomatically. ADMINISTRATION OF PUBLIC HEiALTH. As a result of the late Commission in connection with the recent epidermic, the staff of the department had been materially strengthened, and theroforo it was in a hotter position to undertake ventures that wore practically impossible in tho past. The Royal Commission made certain suggestions with regard to the administration of public health, and it was therefore possible that;'- the department would ta,ke out of the hands of hospital boards all responsibilities as regards the administration of publio health. This, to his mind, was ratner to be regretted, but nevertheless, though hospital boards had taken a great interest in their institutions, they had taken tho very minimum of interest in all_ that pertains to the domain of public health. At the same time, he considered that the boards

would not feel much regrofc for having the responsibility taken away f roiu them. UNIFORM MAINTENANCE FEES. Another question which ho would be interested to hear the opinion of the boards on, was that relating to the initiation of a uniform maintenance- fee system for tho Dominion. He waa of the opinion that the maintenance, fees for tho hospitals generally were far too low ; the fee should not bo less than £3 3s per week.. Some people would say that this would be hard on tho poorer patients, but such was far from being tho case. It was the duty of a hospital board to ascertain, what fees each patient was able to pay, and to render him an account accordingly. It was much easier to reduce the fee than increase it, and if a patient was not financially able to pay the full or even part ol the. maintenance fee, lie bo worried. ACCOMMODATION- FOR WEALTHY PATIENTS. Another matter he desired to drawattention to was the accommodation of patients who were able to pay full fees for medical and nursing attendance. As matters stood, especially in the country districts, the better-to-do patient was badly circumstanced, inasmuch as he was not able to secure treatment in the local hospital, but had perforce to go to a private hospital where the advantages were not to bo compared with those he would receive in a public hospital. Ho was particularly interested in a recommendation on "the subject made by the committee set up to consider the question of a State medical service ac the recent meeting of the British Medical Association in Dunedin, to the ettect that special wards should be erected for patients who can pay full tecs loi medical and nursing attendance, anu he would be glad to hear what members had to say about it P e ™"j '• he considered that hospital acecimniodation of the very best should he available for all classes of the community, and those who were able to pay should be made to pay the full fee for the benefits they receive from the institutions. "BOARDS SHOULD BE RESPONSIBLE." The Minister had referred to the fact that hospital boards were of opinion that some diseases such as tuberculosis and venereal should be treated bv the-State-rather than .by hospital" boards. The whole spirit and Fntention of the- Hospitals Act was to the effect that a board should be responsible' for .the treatment of person in their respective districts for any form of disease, and ho smcereiy hoped that it would continue to be given ""in* inclusion. Dr welcomed the members to the- conference and trusted that their deliberations would result in benefit to the hospital system. _________-