H.—3la.

Although from the description of the facilities of various types already given it will be realized that in some districts the Hospital Boards have made satisfactory provision for the needs of indigent maternity patients, there are exceptions. An outstanding instance is the Auckland Hospital Board district, where, apart from the Franklin Memorial Hospital at Waiuku and a cottage hospital at Warkworth, the Board has provided no institution for normal maternity cases and gives assistance by subsidy to a very inadequate extent. The Committee regards the facilities in this district as entirely insufficient and has made full recommendation in the local report for the improvement of these conditions. In the Wellington Hospital Board district practically no provision has been made by the Board, and although in the city there is at present no serious deficiency owing to the presence of alternative facilities, the maternity services in the Hutt Valley area are very inadequate, and a public maternity hospital in that district is considered necessary. The Committee is of the opinion that in the Taranaki and Hawera Hospital Board districts the assistance at present given by way of subsidy to private hospitals does not meet the public needs in an adequate manner, and "the establishment of maternity annexes at New Plymouth and Hawera, and of a small maternity hospital at Waitara, has been recommended. The Committee also found that in the isolated districts of South Westland and North Westland, and in the Takaka-Collingwood portion of the Nelson district, there was an urgent need for more satisfactory public provision. Recommendations regarding these areas have been, made in an interim report and in the local section of this report. (2) Maternity Hospitals maintained by the Government. The Government, through the Department of Health, at present controls St. Helens Maternity Hospitals in Auckland, Wellington, Christchurch, and Invercargill. (The Dunedin St. Helens has merged with the new Queen Mary Hospital and the Wanganui and Gisborne St. Helens Hospitals have been taken over by the Boards.) These hospitals continue to serve the double purpose for which they were established. They are the chief training schools in the Dominion for nurses entering the maternity service and the only hospitals in which the higher—midwifery—course is now given. They also provide safe maternity care for a large number of women of small means. These hospitals are all conducted on the system of midwife-attendance on normal cases, with a part-time stipendiary staff of medical practitioners, largely specializing in obstetrics, who are responsible for the general supervision of the hospitals, attendance on all difficult cases, and the medical aspects of the nursing training. The fees are £2 10s. per week in the hospital (subject to adjustment), a charge which by no means covers the cost of the service. This fee is sometimes criticized by comparison with that charged when the St. Helens Hospitals were first founded, but it is not realized how vastly more complex and expensive modern maternity care now is compared with the simpler service then given. Although with the growth of Board hospitals giving service of a somewhat similar nature and affording facilities for training the St. Helens Hospitals are no longer the only public maternity institutions, yet they still hold a particular and very important position, in the maternity service. Through their particularly intimate association with the Department of Health these hospitals are able to set a standard of treatment and maintain a uniformity of training which gives a lead to the service as a whole. It has been suggested at times that these St. Helens Hospitals should be taken over by the Boards, but the Committee agrees that there are very definite advantages in maintaining the present system of control. If this is to be the policy, extensive additions or replacements will be required in all the St. Helens Hospitals in the near future. The Committee finds that these hospitals have developed in a highly satisfactory manner in staffing, equipment, and standard of service, but all the hospital buildings are showing deficiencies of greater or less degree. The position regarding the Christchurch St. Helens Hospital is particularly urgent, and the Committee has made full recommendations regarding a new hospital to take its place. The Committee similarly recommends, as the future policy, the development of the St. Helens Hospitals in Auckland and Wellington as the main obstetrical centres for both normal and abnormal midwifery, with resident house surgeons and provision for the clinical training of medical students. (3) Private Maternity Hospitals. Throughout the Dominion there are 191 private maternity hospitals. It will be seen, therefore, that, in the total, they play an important part in the maternity hospital organization. The majority of these hospitals are owned or leased by the midwives who control them. In a certain number of cases they are owned and conducted by doctors.

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