A FALSE STAR

Manawatu Standard, Volume LII, Issue 52, 1 February 1932, Page 3

A FALSE STAR

DUPLICATED HOSPITALS. OPINION OF EXPERT. No. 2.

Most of us are seekers after truth until we find it, and then we like it not, says a further bulletin by the Associated Chambers of Commerce ot New Zealand on the hospital system. There can be no doubt that if the promised local body Commission does its work properly and well its recommendations will be distasteful to many, and this applies as much to the hospital system as to Anything else, since the present system cannot bo justified from the point of view of expenditure and must be reorganised. It was in 1927 that this country had a distinguished visitor in Malcolm 1MacEachern, M.D., C.M., D.Sc., of Chicago, associate director of the American College of Surgeons, and Director of Hospital Activities. He came to the Dominion at the invitation of the New r Zealand branch of the British Medical Association, and with the approval of the New Zealand Government. He spent two months touring the country in an exhaustive survey of the hospital system, having access to all departments of hospital activity, and securing first-hand knowledge and information. Ho then compiled a comprehensive report and left the rest to the good sense of. the New Zealand people. Perhaps it is a characteristic of the latter that they' are far more interested in eulogy than criticism. If Dr. MacEachern’s report had been all eulogy no doubt its phrases would be echoing yet. Because tho report contained some awkward truths also, in the form of helpful criticism, the bulk of its recommendations have been conveniently shelved. If ever, now is the time to bring them out again. The country cannot afford any longer to lull its conscience with excuses. but must occupy itsolf with remedies. THE PATIENT FIRST.

Lest it be imagined that Dr. MacEachern, in his suggestions for economy and efficiency, was cold to the cause of humanity, it is well to quote his iterated and reiterated statement, taken in this instance from the preface to his work: “In compiling this report the writer has at all times taken into primary consideration the. best interests of the patient (this last is underlined)., With this .as a guide, hospital administration and service cannot fail. ...” With this thought uppermost always the writer goes on to give his findings and recommendations, which he emphasises, are intended to be entirely constructive and not in any way CriticalDealing w’ith “major problems for consideration,” he .says: “The writer was early impressed in his work with the large number of hospital districts, having increased—he was informed — from sixteen ns originally intended to 46 at the time of the survey. While perhaps a reasonable increase might be justifiable, there should not be, at present, more than 20 to 21. The multiplicity of hospital districts will defeat the main object of the Act’ as originally, intended, namely, efficiency with economy through the prevention of duplication and the encouraging of centralisation. ... It was generally admitted that the present Dominion hospital system might permit of too much governmental or bureaucratic control, affording direct or indirect opportunity for political influence and interference with policy and possibly management of hospital tending not infrequently to lower efficiency, cause duplication and react against the best interests of economy. It is believed by all, however, that the immediate management of the hospitals is generally free from such influence as outlined above, but it is also generally admitted that the multiplicity of hospital districts was due almost entirely to political influence beyond the control of the Hospital Boards Association and the Department of Health.” All of which is a visitor’s necessarily courteous way of stating the plain fact that political pull in connection with our hospital system has needlessly increased the expense to the tax and ratepayers. Dealing further with this subject under the head of “Economy,” the writer states: “The last, but not least, important fundamental principle applying to the New Zealand hospital system is that of economy. The system as designed had economy in mind through the formation of a limited number of hospital districts with a standard set up in each to prevent widespread duplication and promote better economy.” That being so, the present number of hospital districts in this country must lie economically unsound, and a smaller number would give greater efficiency at less cost. LEGISLATION NEEDED. Dr. MacEachern makes concrete proposals regarding the redistribution of hospital districts, and suggests that a Dominion board be set up, its functions to include the controlling of hospital , policy, particularly as to the limitation of hospital districts, also the co-ordina-tion of districts district boards and activities generally; the board to be composed of representatives of the Department of Health, the Hospital Boards’ Association and the New Zealand branch of the British Medical Association. He states : “A proper redistribution should have the demnnd nnd backing of all the people of the Dominion, and be insisted upon in the best interests of the patient.” The reply to this suggestion is made by the' Department .of Health in the appendix to its report of 1927 that the I3oard of Health already exists, but the comment is added: “But it is the community as a whole, and not any particular section of it, that is represented on the boards, in whom the Act vests the responsibility of the administration of the Act.” Then as the Board of Health is restricted by the Act it should be given the community’s legislative authority to redistribute the hospital districts and make the necessary adjustments in the system. This it is within the power of the local body commission to recommend to the Government, whose own Department of Health is entirely in agreement that there should he a redistribution of hospital districts. It is obvious that substantial economies would result from such a course—advocates of reform place tho figure at half a million. The Associated Chambers of Commerce is not wedded to any particular scheme, but is concerned only in the public interest that the case for the reconstitution of districts—in favour of which there is a body of formidable evidence —should be thoroughly investigated by. the Commission.