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Thursday, 18 October 1956

Mr CHANEY (Perth) .- 1 was most interested in the speech of the honorable member for Dalley (Mr. O'Connor), in support of the bill, but although he said that he was in favour of it, he tried desperately to find in it something to criticize. He said that it was not all that it set itself up to be. The first assertion we have to make in respect of this measure is that it represents an amazing idea on the part of the Minister for Health (Dr. Donald Cameron) and is a very sound step in the right direction, because it will help to overcome the Australia-wide problem of hospital accommodation. Honorable members on this side of the House do not believe that the Government has rushed into the matter without really considering the problems involved, because obviously, a great deal of research has been undertaken. The measure now before us is aimed at alleviation of a desperate position, and I believe that it will be successful.

We are fortunate that, in Australia today, there are in each State voluntary organizations which care for people who are not able to care for themselves and which, by so doing, are reducing the demand for hospital beds. In my own State of Western Australia, there are two such organizations, one engaged in a home nursing service, and the other in a service which, although not strictly of a nursing nature, is of great assistance to elderly people. I refer to the Silver Chain District and Bush Nursing Association which conducts a home nursing service, and the League of Home Help, which provides a " meals on wheels " scheme, so that elderly people who are not able to care for themselves may have at least one good hot meal a day. Because nutrition is being supplied to them, their liability to sickness is reduced, and in that respect it can be said that the activities of the organization are preventing calls for hospital beds in the future. I was interested to hear the honorable member for Dalley say that there was a terrific hospital problem throughout Australia. 1 understand that the authorities who deal with this matter have stated that 8.6 hospital beds for every 1,000 persons are sufficient to meet the needs in any given area. Therefore, if there are approximately eight hospital beds for every 1,000 people, it should be possible to meet the hospital accommodation needs of the future.

Mr Cope - But not for chronic cases as well!

Mr CHANEY - I shall develop thai theme in a moment. In Western Australia, we have the best hospital figures in the Commonwealth. The average number of beds is 8.2 per 1,000. In Victoria, the average is 6.4 per 1,000. I do not know the exact figure for New South Wales, but it is well below eight beds per 1,0.30. However, the authorites there do not agree that even eight beds per 1,000 is a sufficiently high proportion and are aiming at 9.6 beds per 1,000, because they believe that that proportion is necessary to meet all requirements.

Various methods have been adopted to alleviate the shortage of hospital beds. I disagree with the honorable member for Dalley that what people really need is free hospital treatment, not voluntary care. I believe that if a government does anything to discourage voluntary effort in the community it has not the interests of the nation at heart. Australians are totally dependent on voluntary effort in numerous fields. Home nursing is one of those fields and is one of the most praiseworthy. 1 have in my hand an article written by Gavin Casey, a well-known Australian writer, who is at present undertaking research into various problems in Western Australia. The article appeared in the publication " Hospital Administration ", and reads as follows: -

Aged people must, as far as possible, be kept out of hospital beds for three reasons. The most important of these is that bed is bad for them. Another is that hospital beds are needed for people who are ill, rather than old. The third is that it costs the community too much to maintain them with trained hospital staff at their beck and call.

In Western Australia, for instance, a group that makes up only 7.39 per cent, of the population occupies more than 30 per cent, of the hospital beds. According to doctors of the Western Australia Public Health Department there would be no shortage of accommodation for the ill if, by some magic means, all these people of the " over 65 " group could be accommodated elsewhere.

Even if all sorts of other arrangements were possible they could not all leave hospital, of course, for many are truly ill as well as aged. But students of geriatrics (the care of the old) throughout the progressive countries of the world have been astonished at the large numbers of old people who need not, and should not, take to bed in their declining years.

He goes on to say that patronage is resented and any old person, told by the doctor that he must go to hospital, first of all raises violent objections. He thinks of a hospital as a place where old people die and he thinks he is capable of looking after himself, anyway. Then having been hospitalized and having found that he is in a delightful ward with delightful surroundings, with some of the latest colour schemes on the walls, and that the wards are calm, clean and quiet, that the nurses are obliging and the food warm, varied and served on time, nobody is going to get him out of there again. When the time comes for his discharge he finds he is suffering from some other ailment, that he has a toe ache, a backache or a neck ache, and he longs to stay in surroundings which were better than those he has had for a long time. That person, as well as those who are chronically tick, must be taken into consideration. I do not think that this bill was ever designed to offer treatment by visiting sisters to those who are chronically sick and who would normally be hospitalized. It is aimed, however, to cover those who need attention only in their homes. That attention can be given to them and they will not use a hospital bed to the detriment of somebody who is in a much worse state of health.

Western civilization has changed. In nonindustrialized countries, such as India, the problem of the aged is not as great as it is in the civilized, industrialized countries such as Australia. In India the family is still the centre of the social unit. Regardless of the age or condition of a person, there is still room for him in the hut or house, or whatever it is and nobody begrudges the small amount of rice that goes into the bowl each day to keep that person alive. Here, the big family idea no longer exists. We have given up the idea of the young looking after the old and we have a tendency to look to the Commonwealth or the State to do the work that in the first place was the responsibility of the person himself.

The honorable member for Dalley expressed concern that, although this bill provides that aid will be given to any organization if it is not under the direct control of the Government, religious organizations will not become eligible for the subsidy because they do work as a labour of love and do not receive payment. The bill covers that situation. Payment can be made on the basis of what those people would receive if they were working under award rates.

I return now to the Silver Chain Association in my own State. This bill will not only lessen the call on hospital beds, but also provide a great advantage in the encouragement it will give to people who have worked in a voluntary capacity for so many years, doing a service without any thought of reward. Among the office-bearers of the Silver Chain District and Bush Nursing Association of Western Australia - and I venture to say among the office-bearers of any of these organizations throughout Australia - are to be found persons who are associated with countless other charitable undertakings and who are leaders in the business and commercial life of the State. Those men and women are devoting their spare time, and sometimes time that can scarcely be spared, to the cause of people who are worse off than they are. If one of the results of this bill is the encouragement of those people, then the bill will have given us something worth while.

One thing that the bill will not do - and there are sufficient safeguards to see that it will not happen - is that it will not deter those who have made contributions in a voluntary capacity to the organizations in existence, so that in the future they themselves may think that it is the responsibility of the Commonwealth. Looking quickly at the bill, I would say that the clause limiting the amount of subsidy to an amount equal to that granted by the State will be a good safeguard and that the State will continue to pay a subsidy to those organizations.

Mention was made of the cost of a visit by a home nurse. I think the figure given was 10s. The whole basis of the measure is not what it will cost to visit somebody at home, but how much need there is for a visit. If the person is not capable of paying anything, the nurse will not be prevented from making a visit. No means test is applied and the visit is made where the necessity arises. In Western Australia, about 69,000 visits were made during the year, and the total collections from those visits were in the region of £5,800. It is safe to say that the visits would have been made to people in all strata of income and that some people may have been quite willing to donate £1, £2 or 10s. for a visit. The average is about ls. 8d. a visit, which shows that a lot of work is being done at no cost to the people concerned.

There has been a rapid development. I said earlier that Western Australia had 8.2 beds to each 1,000 of population. We certainly have insufficient beds in the metropolitan area, because the figures are taken on a State basis. Some country hospitals may have a surplus of beds because of the moving population. We have had quite a lot of that because, perhaps, the timber industry has changed its place of operation or the population of mining towns has decreased. But in the metropolitan area, with the concentration of population, there is a distinct shortage and the figure for that area would probably fall well below the average of 8.2. I think that in every State the private hospitals which existed in the days before the last war have slowly disappeared. I know the immediate reaction is to atttribute this to rising costs and the state of the economy. But it is always well to remember that other factors are involved.

I suppose those whose conditions have improved the most in those periods are the nurses at hospitals who, prior to that period, were housed under shocking conditions in many places and- many hospitals. I take as an example the Wangaratta Base Hospital.

I do not know it, but I have some information here about it. In 30 years receipts and expenses have increased 30 times. The annual bed cost in 1924 was £90 and to-day it is £1,156. The staff in 1924 was one to each two patients. To-day it is two nurses to one patient. It can be seen, therefore, that increased staffing, different conditions and better awards for the staff - and I think that nurses and other people who work in hospitals have been brought under much more favorable conditions - have all contributed to the higher cost of hospital administration.

We have reached the stage where something must be done to care for the aged and the needy who do not require treatment for chronic sickness. It is estimated that the cost of building a modern hospital is £7,000 for each bed provided. I am not sure that this estimate includes the cost of provision of nurses' quarters. There are some very beautiful hospitals in Western Australia, and I quite agree that our hospitals should be the finest buildings that we can erect. They should be the best that science and man's ingenuity can design. But alongside them there are magnificent buildings that house the nurses, and those buildings add to the colossal cost of hospitalization.

Another difficulty may be encountered after this bill becomes law. Although the need for nurses exists, and although the money may be available to provide them, it may be difficult to find people to fill the positions. The duties of a visiting sister are quite different from those of a resident sister in a hospital. Something extra is needed of her, and the position of visiting sister may not attract every person trained in the nursing profession. This difficulty may be overcome. One of the Opposition members has said that there is a terrific shortage of nurses in his State. Steps have been taken in Western Australia to overcome the shortage of nurses in that State, by making the profession attractive to those entering it. Girls are given financial encouragement to enter the nursing service. The policy adopted is similar to that followed by the .Education Department in Western Australia, which offered bursaries worth about £80 to students in their fourth and fifth year of high school who would guarantee to train as teachers. By that simple method, sufficient trainees were found to fill the training college. I believe that the nursing authorities have offered a similar incentive to girls who are proceeding to higher education, if they will promise to take up nursing as a career. I always think that a lot of idealism attaches to nursing and other activities associated with the sick, and the method of attracting people by monetary means has disadvantages as well as advantages. I also feel, however, that those who are not suited temperamentally to the profession will not stay in it for very long. The subsidy scheme in Western Australia will help to obtain more nurses to do this necessary work. The last annual report of the organization about which I have been speaking contains the following comments: -

It is clear that the increasing financial burden cannot be met by the resources of a voluntary body. Subsidies granted by the State government, begun eight years ago, have had to be increased each year. We place on record our appreciation of the Western Australian Government for financial assistance and for the sympathetic understanding shown by the Medical Department in relation to the problems which confront the " Silver Chain ".

The report says that the problem is an urgent one, and that a modern hospital is a most expensive institution. This is quite obvious when it is considered that the cost of a hospital works out at £7,000 a bed. The report continues -

There are, however, nol a few cases where home conditions are entirely unsuited to nursing, for example, where the patient is living alone. Others need welfare officers who can spend much time and infinite patience in helping to straighten out domestic, financial and other tangles.

The nurses engaged in this work often have to be more than simply nurses or sisters administering a needle or providing some form of medical attention. They become the friends and advisers of the persons whom they treat. They provide shoulders for these patients to cry upon. They are the persons to whom some of the patients turn for solutions of all kinds of problems. Though it may be a humanitarian act to provide this kind of sympathetic assistance, it results in the sisters being unable to visit as many persons as they may wish to.

It is rather interesting to note in the balance-sheet that a major part of the expenditure of the organization is taken up by salaries. The nurses have light motor cars, which cost little to run and are economic propositions because they enable the nurses to visit many more people than they could visit if they were compelled to use public transport. Of a total expenditure of £23,076 for district nursing activities in the year, the salaries of the nursing staff amounted to £14,997. For the benefit of those who speak of complete socialization of hospitals and medical services, it would be interesting to compare a balance-sheet of this organization, which is a voluntary body, with that of the completely socialized medical service in Great Britain, about which much has been said.

The receipts side of the balance-sheet shows that the Western Australian Government subsidy amounted to £17,000, but 1 am fairly sure that this amount represents an overall subsidy. Besides conducting the district nursing service, this organization also conducts cottage homes for elderly persons, and the Alfred Carson Hospital, which is in the Claremont region, and I should imagine that the subsidy of £17,000 would cover the three undertakings. The organization also received from the Lotteries Commission of Western Australia an amount of £2,500. I hate to think what the hospitals position would be in Western Australia but for the assistance given by the Lotteries Commission. I think that that commission has operated for about 20 or 25 years. It has practically financed the building of most of our hospitals, and it has supplied amenities not only for the hospitals but also for aged persons' homes and similar institutions. Whatever objections there may be to the conducting of lotteries, they seem to me to constitute a very subtle form of indirect taxation, the receipts from which go to an extremely good cause.

Mention has been made of the costs of hospitals. It is always a source of wonder to me that the salaries offered for some of the positions in hospitals are so low. I noticed with some interest recently an advertisement for a fully qualified tutor sister, for whom a salary of about £730 a year was offered. That is about the amount received by the secretary df a member of this Parliament, and it is less than would be received by the confidential typist of a manager of a commercial undertaking. An administrative assistant who is needed for hospital administration work, and who must be a university graduate, is offered a salary ranging from £1,216 to £1,260. Although hospitals cost £7,000 a bed, it is obvious that difficulties will be experienced in obtaining staff to fill some of these positions. But I hope that, whatever difficulties are experienced by other bodies, the Silver Chain organization of which I have spoken to-day, will be able to obtain the staff needed to carry on its work, which is designed to reduce the need for hospital beds in Western Australia.

In conclusion, I wish to say that whatever criticism may be offered of this measure - and as yet 1 have not heard any, and I doubt very much whether any one could properly criticize the principle behind it - the Minister who presented the bill should be congratulated on making a move towards assisting organizations that depend mainly on voluntary efforts. If these organizations are encouraged by us, we will be doing a service, not only to the sick and the aged, but also to every other person in the community, and perhaps, in this materialistic age, we may regain some of the idealism that used to grace the thinking of our forefathers. I congratulate the Minister once again on this bill, and I support it in its entirety.

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