HOSPITAL SYSTEM ASSAILED

Sun (Auckland), Volume IV, Issue 1059, 25 August 1930, Page 1

HOSPITAL SYSTEM ASSAILED

WELL-KNOWN SURGEON’S VIEWS ' SAYS PRESENT BOARDS SHOULD BE ABOLISHED IMPORTANT RECOMMENDATIONS PRESENTED NEW ZEALAND’S hospital system is keenly assailed by Dr. Campbell B egg, the well-known Wellington surgeon, who has returned from the Medical Conference at. Madrid, and from an extensive tour of the Continent, Britain and the United States. Dr. Begg blames the system of hospital control, by boards elected as at present, for much of the trouble, and presents recommendations to put the system in order.

.Press Association WELLINGTON, Today. Dr. Campbell Begg, the well-known surgeon, -was a passenger by the Makura, which arrived from San Francisco today, after an absence abroad of six months, during which he attended the Medical Conference at Madrid, and spent the remainder of the time visiting the principal hospitals of the Continent, Great Britain and America. He investigated the working of over 100 institutions in the United States, Canada, Great Britain, France, Germany and Spain, and he interviewed persons of all kinds in any way interested or concerned in the control, administration and daily round of these institutions, including some of the best-known people in the medical world.

The conclusion arrived at by Dr. Begg was that New Zealand can derive little satisfaction from the present position, on account of our splendid system of general education and a certain independent outlook not prevailing in older countries. New Zealand’s medical and nursing professions are equal to those of most countries, and superior to many. Our public hospitals on the other hand, largely on account of a method of control now almost universally abandoned elsewhere, compared unfavourably with the hospitals abroad. The medical staffs in New Zealand were badly organised or not organised at all; appointments w-ere haphazard and there was a lack of the co-opera-tion and good feeling between the staffs and boards of control that existed elsewhere. As a result, fhe difficulties of handling large bodies of patients effectively was accentuated or rendered impossible. The average stay of patients in hospital, both for treatment and diagnosis, was far too long, and the organisation of the nursing service was insufficient.

In New Zealand there was too little supervision of the work of junior men by senior ones, and too much scope for hasty and wrong methods of treatment on the one hand, and neglect of thorough investigation on the other. Equipment was bought and additions carried out on the advice of superintendents, where only specialists in the different departments were capable of real direction. Chronic cases were mixed up with those requiring real medical and surgical attention, and the services of the staff were dissipated instead of being concentrated on the effective medical and surgical part of hospital work.

Infectious cases in New Zealand were under the same superintendence as others, an arrangement at variance with all modern practice, and as a rule these cases were deprived of the benefits of the visiting staff.

All these disabilities were due in large measure, if not entirely, to our system of boards elected every two years. Dr Begg goes on to say: “It has been found that men of the requisite standing will rarely submit to the disagreeable experience of such an election; that boards so elected are far too unwieldy; that members will not give themselves up to the study of hospital management, but simply look on membership on the board as the first step on the political ladder; members give sufficient attention to the routine matters brought before them, but are hopelessly incapable of constructive work; the more capable members are swamped by others, and possibly not re-elected if they adopt a policy for the good of the hospital which is at variance with some political slogan.’

After instancing examples of capable management in the States, Dr. Begg adds: “Our hospitals in New Zealand have become purely political. A Minister from the dominant party in power Is in general charge, and national politics have invaded the board eleotions. Much political propaganda undermines the whole hospital structure, and some of it had unfortunately found its way to the statute book.” The present system had run its foil course, and there was an urgent need that our reproach in this sphere should be taken away. Dr. Begg goes on to make recommendations to effect this. He says our future development lies in cooperative effort, and the Mayo Clinic, in New York, has furnished the example. Dr. Begg’s hospital recommendations are as follow: — . . (1) The immediate repeal of the relevant section of the Hospital Act, and the abolition of elected boards in the four main centres at least. (2) Nomination of boards of trustees for the hospitals by those who find the money—namely, the City Councils and the Pri-pe Minister’s Department, representing the Consolidated Fund. (3) Restriction in the numbers of these boards to four members, who must be men of standing in the world of finance or accountancy. Certain undertakings not to engage in politics during their period of office, which should extend to *t least five years, iB imperative. (4) A Social Service Committee to be organised by the board, not only to look after cases of distress, but also to assess what Is a fafr charge for hospital maintenance. (5) The exclusion from pnbUs hospitals of all those who may fairly be asked not to be a charge on the public; that is, those who are ahl* to pay fees to cover maintenance. H no proper private facilities are available, it should be permissible to admit these at a rate which will cover overhead expenses and produce a profit, and the attending doctors should also be remunerated. The size of the hospitals and the expense of running them would be thus reduced. (6) Separate provision tor chronic and incurable cases, dr those who go or are sent to hospital merely because It is not convenient to have them looked after at home. (7) Separation of infectious diseases hospitals from general and surgical hospitals. They might be put under the care of the local health officer, or have a special board nominated for them. Honorary physicians and surgeons should be separately appointed. (8) Medical boards should be organised, consisting of the heads of the more important departments. These heads should be appointed as such, and not merely be the senior men. All appointments to the staff should be recommended by this medical board, and'not by outside practitioners or a consulting staff of retired doctors, who cannot be in touch with current requirements.