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Thursday, 18 October 1956

Mr LESLIE (Moore) . - 1 am sure that the House will agree with me when I say that we have had a great privilege in hearing the honorable member for Herbert (Mr. Edmonds) in a very delightful role, for a change, a very delightful role indeed, commend the Government, the Minister for Health (Dr. Donald Cameron), and, deservedly, the departmental officers concerned with the production of this legislation. It is to be hoped that we shall hear the honorable member speak in a similar vein on future occasions rather more frequently than we have heard him in the past. We thoroughly enjoyed the experience.

However, I wish to correct what appears to be a misunderstanding on the part of the honorable member about the remarks of the honorable member for Perth (Mr. Chaney). I listened very carefully to the honorable member for Perth, and not for a moment did I believe, when listening to him, that he implied that the conditions of employment in the nursing profession to-day were ideal or, as the honorable member for Herbert put it, that nurses were being well looked after. The honorable member for Perth referred to improved conditions in the nursing profession, and gave as an example the improved accommodation now provided for nurses in hospitals. But I direct the attention of the honorable member for Herbert to the fact that the honorable member for Perth, in the closing stages of his remarks, particularly emphasized the poor remunera tion that nurses receive in comparison with the pay of other sections of the community. So I think that the honorable member for Herbert can rest assured that the honorable member for Perth is fully alive to conditions in the nursing profession to-day, and knows that they are anything but satisfactory, or as satisfactory as they might be.

The House is considering a comparatively small bill which might be regarded by some as of no particular significance. But, in my opinion, it is a measure of tremendous importance and significance. I, too, Mr. Speaker, wish to add my meed of praise to the Minister, the Government and the departmental officers who have adopted the principle which underlies the measure.

Mr Daly - That is an unusual role for the honorable member.

Mr LESLIE - I am not aware of the outside associations of the honorable member for Grayndler (Mr. Daly), but I am speaking, Mr. Speaker, with the background of a very long association with the work of the bush nursing organization and the activities of home nurses and hospitals, and of hospital boards of which I have been a member for many years. As a result of my experience I am fully aware of the problems incidental to this whole matter. The Silver Chain District and Bush Nursing Association, to which the honorable member for Perth so kindly referred, is an organization which started entirely on a voluntary basis. Trust funds were ultimately established as the result of contributions, donations and legacies, and that organization took on a work of tremendous value in providing nursing assistance where nursing assistance was most greatly needed. Throughout the length and breadth of Western Australia, for instance, we find what are called, very modestly, " rest homes ", which are provided in conjunction with local hospitals in country districts. Their object is to provide a place where expectant mothers can receive attention prior to entering hospital for confinement and also have a rest period immediately after leaving hospital, and where other people who require nursing attention for illnesses the treatment of which is not of an urgent nature may also receive the benefit of such attention as well as the benefit of rest. That association has done a tremendous work in Perth, but it is its activities in the country districts with which I was personally associated. For a very long time it was a struggle to get governments to recognize that the work of the association was worth while and was not just somebody's silly idea of creating more work for voluntary workers.

Mr Duthie - Those were Liberal governments, of course.

Mr LESLIE - I am afraid that my friend is quite right, but I do not want to enter into a political argument on that aspect of the matter. The day has arrived when governments are recognizing that the work which was started by good citizens out of the fullness of their hearts was not extraneous work, but was work that governments were not doing although they should have been playing a part in it. A study of the history of what one can only call welfare and social activities will show that in every case the genesis of the organizations engaged in such activities has been a sense of Christian fellowship, the kindly regard of man for his neighbour and concern for his neighbour's welfare, and that only later have governments come into the picture on an official basis.

So, there is an important principle in this legislation: This National Government has recognized the necessity for a nursing" scheme of this kind, has realized that nursing attention is required not only in hospitals but also in the homes of sick people. I disagree with the statement of the honorable member for Dalley (Mr. O'Connor) about the medical profession. I regret that he made the remarks he made, and I hope he did not mean them in the way that I understood him, at the time, to mean them. He said that the standard of the general practitioner in recent times had degenerated considerably compared with the standard in the early days of the medical profession. He laid the blame for that on the modern tendency to specialize. I disagree with him entirely, and I think that if he cares to analyse the vital statistics he will find that, on the contrary, the general practitioner today is as efficient as, or more efficient than, his predecessor.

The modern general practitioner realizes that there are better facilities available than he is able to provide. The general practitioner is, as the term indicates, a man who engages in a general, non-specialized medical practice. In the early days, when there were no specialists, general practitioners were called upon to do work which many of them will admit was beyond their particular skills. Whereas, in those days, a patient had to risk having his ailment treated by a general practitioner, to-day skilled specialist treatment is available. The modern general practitioner knows his limitations. The outback practitioner, especially, is honest and will unhesitatingly refer a patient to a specialist if he feels that a certain illness is beyond his capacity. The result is reflected in the fact that the number of deaths from many illnesses has fallen over the years. In my opinion, the standard of the general practitioner has increased considerably. A higher standard is demanded of him nowadays, because the specialist, with his greater knowledge, acts as a critic. The general practitioner must know something about the cases that he refers to the specialist, because if he refers cases unnecessarily he will soon lind himself with an unhappy reputation.

I would very much prefer that the Commonwealth's contribution to the work of voluntary organizations should be tied up not with the contributions of the State governments, but with those of the voluntary organizations themselves. The biggest problem facing these organizations is finance. Governments are usually approached to make up the deficiency between the voluntary contributions and the running cost. As a result, to some extent voluntary contributions are limited because people say, " The Government will come good ". It would be better if the Government said, " If you will help yourselves we will help you to the same degree ". That would provide the perfect tie-up between voluntary work and government aid, and would encourage voluntary organizations to expand their operations. In schemes of this kind, where the State government comes into the picture, I would like to see financial responsibility shared in a new way. The organization, by way of voluntary contribution, could meet one-third of the cost, the State government could meet one-third and the Commonwealth could provide the other third. That would give us the perfect relationship. I want to stress that we must encourage voluntary organizations to do their share, and more.

Mr Duthie - Does the honorable member suggest that the total cost should be met in this way?

Mr LESLIE - Yes. I am sorry that the honorable member for Herbert (Mr. Edmonds) is not in the chamber, because he would agree that the spastic organization of Queensland provides a splendid example of the successful working of such a scheme. The work of the organization has expanded because the Queensland Government pays a £l-for-£l subsidy. Such an apportionment between voluntary contributions, and those of the State and the Commonwealth Governments would be ideal.

To-day we often speak of citizenship, and every year we gain thousands of new citizens from among immigrants to this country. 1 sometimes wonder whether we stress sufficiently the difference between being a subject of the Queen and a citizen of a country. It is so easy to be a good subject. One has only to obey the laws and carry out the obligations to which one is sworn. That is the beginning and end of becoming a good subject. We have many good subjects but too few are good citizens. The good citizen is not only a good subject of the Queen but also understands, and attends to, the needs of his fellows. In other words, he does a little more than he expects to be rewarded for. Being, a good citizen involves taking an interest in what goes on around one, and making a contribution to the welfare of one's neighbour. That ought to be encouraged in every field of public activity. The matter before us provides an avenue for that encouragement. I am not criticizing the Government's contribution but am merely suggesting - it might be an entirely new thought - that the Government should provide both the substance with which the work can be carried on and expanded, and the encouragement to voluntary contribution which is the mark of good citizenship. If Government supporters were subject to those conditions r, as a citizen, would be encouraged to give more. I would know that whatever F gave would be doubled by the addition of the government subsidy. That angle is surely worthy of consideration.

The Minister said, in his second-reading speech, that hospital service can never be a true substitute for the family doctor. I could not agree more. All my life I have been opposed to the centralization of hospital services, and the building of huge metropolitan or regional hospitals. In common with the Minister, I believe that a person who needs care and attention should receive it as near as possible to his home and loved ones. The treatment of illness and incapacity has a psychological aspect, lt is not merely a matter of giving pills, potions, powders and injections, or providing good nursing by a paid nurse. The patient must be given the desire to live, and that cannot be done if the patient is in Sydney and his loved ones are out in the Riverina. The patient feels lost in a huge hospital, and out of touch with his own folk. He should be where his loved ones can see him frequently, and can spur him on to resist the inroads of illness. Once that is done the medicine he receives is well on the way to being effective. No doctor can save the life of a person who doss not want to live. No one can assist a person to get well if he will not assist himself. That principle is inherent in the bill. The temptation to send people to hospital often leads them to an early grave.

I am wondering whether it is wise to state in the bill that, for the purposes of the legislation, the word " nurse " shall mean a trained, registered nurse. The Minister, in his second-reading speech, referred to the fact that many of the people who will receive nursing attention under this scheme will not be in need of hospital attention or skilled attention from a trained person. I am inclined to agree with the honorable member for Herbert that not enough trained persons will be available to operate the scheme. There are many occasions when a person who is incapacitated by either age or the after-effects of an illness does not require the services of a trained nurse. The attention that is required is attention of the kind which, in a hospital, is given effectively and efficiently by trainee nurses or by what we call nursing aides. I think that we should do a great deal to increase the efficiency of the scheme if we widened the definition of " nurse " to include a nursing aide. I put that suggestion to the Minister so that he can think about it during the next twelve months or so.

The nursing aides, of course, would have to be trained to a certain standard. They would have to be competent to give normal home treatment. In hospitals, nursing aides and trainee nurses wash and turn patients and provide many other kinds of attention, whilst the trained nurses, who have a higher degree of medical knowledge, act as watchdogs, so to speak, for the doctors. If we extended the definition to include nursing aides, we should be doing something more to achieve what the Minister and the Government have in mind. There may be objections to the employment of nursing aides, but it would appear to have definite advantages in that it would make more trained people available to give skilled attention. 1 spent a couple of years in a hospital, and during that time I think I received more attention from nursing aides than I received from the trained nurses.

There is another aspect of the matter that I should like the Minister to consider. There are some activities in the field of nursing, I think it could be called, which will not be covered by the bill. Occupational therapists and physiotherapists are employed by organizations such as the spastic welfare associations to give treatment to young children, sometimes extending over a period of years, with the object of helping the children to overcome disabilities. I believe that assistance should be given by the Government to organizations such as the spastic welfare associations which provide skilled professional attention for persons in need of it. If spastic centres were not available, many physically handicapped children would seek treatment at a hospital. Generally speaking, that would be the only place at which they could obtain, without charge, the attention that they needed. Spastic welfare organizations are relieving the hospitals of a considerable burden. That means that the skilled staffs of the hospitals are able to devote their attention to more urgent cases. If all spastic cases were referred to hospitals, an impossible burden would be placed on hospital staffs. These associations are doing work similar to that which is being done by the nursing associations. By providing equipment and skilled staff for the treatment of persons who require long courses of treatment, they are lifting a burden from the hospitals. Their work is carried on without profit, because no charge is made to the parents of the children who are treated.

I appreciate that in this scheme the Government is entering a new field. Therefore, I refrain, as an ordinary member of he Parliament, from criticizing the pro visions of the bill which, in my opinion, will give a little too much authority to people outside the Parliament to make decisions. I hope that when the scheme takes shape finally, we shall be presented with a measure to tie up the loose ends, which must be allowed to remain untied for some time. I realize that the scheme is in the experimental stage and it is with a desire to help that I have submitted my proposals, for consideration.

I appreciate deeply the move that the Government is making in the bill. I think that the Minister is deserving of all the credit that we can give to him. Our thanks to him and the officers of the department have already been expressed, though perhaps not very generously. I have no doubt that the Minister played a big part in the preparation of the scheme. I persuaded him to attend an annual conference of the spastic welfare associations that was held in Queensland last year, and I know that he convinced the delegates to the conference of his sincerity. In this bill, he is giving effect to his desire to achieve better conditions for a section of the people that is deserving of them. I support the bill.

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