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Thursday, 18 October 1956

Mr O'CONNOR (Dalley) .- The Opposition supports the bill. I compliment the Minister for Health (Dr. Donald Cameron) on the part that he has played in its preparation. It opens up a wide field for discussion, and I propose to be rather more critical of certain aspects of our health services than was the Minister. He made some quite critical remarks 'about the shortage of hospital accommodation, the lack of hospital staff and the like, but I do not agree with his diagnosis of the -causes of those shortages. Let me emphasize now that the views that I shall express are my own views only. The Minister explained that the bill was related to domiciliary medicine and he expressed the view that the standards of the general medical practitioner would tend to improve. He stated that, in his opinion, those standards were very high to-day. It is good to know that the Minister holds that view, but there is abundant evidence in support of the contrary view. There is evidence that, compared with 30 or 40 years ago, the standards of the general medical practitioner have deteriorated! due to the tendency of members of the medical profession to specialize, rather than to concentrate upon performing the functions that the general medical practitioner performed 30 or 40 years ago.

Specialization brings with it the spectre of even larger hospitals. There seems to be no limit to the size of our hospitals. On this subject, there is a conflict of opinion amongst the authorities but, apparently, the prevailing view is that the larger the hospital, the better it is. However, there are many authorities who disagree with the theory that the bigger the hospital, the greater are the facilities that it provides and the better are the services that it renders. I know that there are members of the medical profession holding high administrative posts in this country who are constantly demanding that hospitals be enlarged. They disagree with the view that a hospital with 500 or 600 beds is, in terms of size, adequate to perform the normal functions of a hospital.

Cost is a factor that should be borne in mind by governments throughout Australia in considering whether the practice of building hospitals with almost no limit to their accommodation is wise and in the best interests, not only of the members of the medical profession but also of the patients. I say quite definitely that big hospitals tend to foster an impersonal atmosphere, rather than the personal atmosphere that is so necessary for the successful treatment of sick people. The trend towards larger hospitals is, in my opinion, a phase of automation, and if hospitals are enlarged to the point where patients are regarded merely as numbers the personal touch will be completely lost and there will be a completely adverse effect upon them. Some organizations and members of the medical profession to-day display a tendency to discharge patients from hospital altogether too quickly. I know that on this score, in tilting the lance at the medical profession, I may be accused of not knowing what I am talking about. However, I am prepared to take that risk. The attitude of hospitals to-day is completely different from their altitude twenty years ago. An immediate nation-wide inquiry into the - approach of hospital administrators to this matter is justified.

I regret to say that the approach to the treatment of aged persons who need hospital attention is utterly deplorable. When an aged person desperately needs hospital treatment, sometimes disclosure of his age leads to refusal of admittance. I think that to-day the idea that old persons are not entitled to hospital accommodation and treatment is altogether too prevalent. This attitude cuts completely across all the canons and precepts of the medical profession as we know them. Hospital administrators always advance the argument that a shortage of beds exists. That may be so, and a number of factors are responsible for that state of affairs. I have no doubt that almost every hospital in the Commonwealth would be able to cater for more patients if it could obtain additional staff, but I submit that not only the question of staff is involved. Also involved is the matter of finance, and hospitals, particularly State hospitals, are dependent in the final analysis upon the assistance they obtain from this Government, which must accept some responsibility because it is restricting advances to the States. The States have numerous responsibilities, and they can allocate to hospital services only a certain proportion of the amount received from the Commonwealth. There is no escaping that fact, because finally the Commonwealth determines precisely the amount of money the States will receive. When that determination is made, the States in turn determine how much they will spend on maintaining existing services and building new hospitals.

It was a deplorable step on the Government's part to bring an end to free hospital treatment which was available under the Chifley Administration. In those days we did not encounter some of the difficulties which we meet to-day. It is useless for the Government to say that it is impossible to provide free hospital treatment, when such free treatment is provided in Queensland. One appreciates the contrast between the position of persons who live in a State where they are not called upon to meet medical and hospital bills, and the position of those who live in States which do not provide free medical and hospital services. The cost of hospital treatment to-day is so high as to place a very heavy burden on persons who have to undergo hospital treatment. The Government's approach to this problem is therefore open to criticism simply because it is not a national approach. The Government proposes by this measure to provide limited assistance which will not add up to very much in the long run. On the other hand the Government abolished free hospital services, and I have not the slightest doubt about what the people would say if they were asked whether they would prefer to return to the conditions when free hospital services were provided or, alternatively, to meet the enormous expenses which result from illness to-day.

The Minister said that the cost of each visit of a member of a nursing association was about 7s. I am not correcting the Minister in a critical way when I say that there is also a point of view that differs from his in relation to that matter. A letter over the name of Elizabeth Teece, the chairman of the board of the Sydney District Nursing Association, was published in yesterday's " Sydney Morning Herald ". In the letter the statement appeared that the cost of each visit by a member of the association was 10s., and that the number of patients visited last year totalled 2,797. The contributions received averaged ls. 7d. a person. The patients are not obliged to subscribe, and the members of the association visit many persons who are not in a position to pay. Members of the association visit and care for patients, and, in addition, administer free drugs. The experience of the association, which I think is as large as most organizations of this kind, has been that each visit costs 10s. A point which intrigues me is that the Minister went on to say that the subsidy to be paid under this measure is not to exceed the State subsidy. I should have been much happier had the Minister been able to give the House some idea of just how much money will be involved as a result of the passing of this measure. The Minister stated the conditions which will apply after a certain date and how the subsidy would be payable. We are not in a position to say anything about the cost of the scheme, simply because that information is lacking. Further, it appears to me that this measure has been completely tied up in such a way that the Government will not be called upon to pay very much in the long run. The Government suggests that what it proposes to do will make a major contribution towards rectifying a problem. However, no one knows just how much this will cost the Government. In my opinion, the assistance will be so effectively hamstrung that it will be almost impossible for many organizations to benefit.

I am intrigued by a particular aspect of the measure, and perhaps the Minister will enlighten me when he replies. The honorable gentleman stated, in his second-reading speech, that the Government proposed to recognize the work of religious organizations in this field. I have in mind two organizations in Sydney, one run by the Methodist Church and the other by the Catholic Church. Assistance is to be provided on the basis of the number of people employed, but the Brown Sisters, members of a Catholic nursing organization, do not receive any salary at all, and therefore cannot be classified as employees. Notwithstanding the statements of the Minister in this respect, I can see no way in which organizations of that kind will be assisted under this legislation.

In principle, I support the bill, because 1 think that it will assist those who are urgently in need of assistance. At the same time, I. am of the opinion that the Government has painted a misleading picture of the benefits that will flow from the measure. For instance, it has been said that, as a result of this legislation, more beds in public hospitals will be available. I believe that a more appropriate approach to the problem of hospital accommodation would be for the Government to make more money available to the States, so that they could build more hospitals. It is the practice of certain organizations - and I do not criticize them for it - not ,to visit patients unless they are referred to them by medical practitioners or hospitals. There are in the community many people who, although not chronically ill, are in need of attention, either because of the disabilities of old age, or because of relatively minor illnesses. Whether organizations which cater for the needs of such people will receive assistance under this bill, the Minister has not yet made clear.

As honorable members are aware, hospital accommodation in this country has reached a deplorable state. This Government has aggravated the difficulties by its attitude to the Chifley Government's hospital benefits legislation. Because of that, the demand for hospital beds has reached unmanageable proportions and is increasing daily. The lamentable stage has been reached at which people who seek hospital treatment are asked their age before they are admitted. That should not be tolerated in a civilized community. It seems that no one knows the precise number of people who are waiting for hospital beds in this country. I have before me reports prepared by the New South Wales and Victorian hospital commissions, and whilst they contain statistics concerning many phases of hospital activities, there is no reference to the number of people in urgent need of hospital treatment and unable to obtain it because of lack of beds.

I submit that the shortage of hospital accommodation cannot be overcome by legislation such as that now before the House. The position calls for a more energetic approach and for recognition by the Commonwealth that it has a responsibility to the States in this connexion. The Commonwealth must appreciate that it is impossible for the States to bear all the burdens that are being imposed on them to-day, due, in large part, to mounting building costs. I suggest that if the Government really wanted to do something tangible to relieve the position it would provide for free hospital treatment, instead of granting subsidies to particular organizations.

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