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Thursday, 18 October 1956


Mr JOSKE (Balaclava) .- The bill provides for the grant of subsidies to home nursing organizations, which was visualized by the Treasurer (Sir Arthur Fadden) when he presented his budget this year. In other words, it is a part of the plan of the Government to provide for the care of the aged and the sick in the community. The Minister for Health (Dr. Donald Cameron) must be very gratified that the bill has been received so well. It is a long time since we had a bill for which all parties and all members commended the Minister so much. I add my bouquet of congratulations to the many others that have been handed to the Minister. He must feel that to-day is really a red-letter day in the sense that it is roses, roses, all the way. In the course of what we believe will be a long and successful career as Minister for Health, doubtless he will receive many more bouquets.

While one gives praise to the Minister, it should not be forgotten that the officers of his department have assisted him and have done a great deal of work in providing the material upon which he was able, with all his skill and specialized knowledge, to form the opinion that this bill was an excellent measure. I should like to include the officers of his department in the congratulations which I have extended to the Minister.

For very many years, home nursing organizations have been carrying on with very little government assistance. In the main they have been voluntary organizations. I was somewhat dismayed to hear the honorable member for Wilmot (Mr. Duthie) express the opinion that, so far as he knew, Tasmania did not have any voluntary organizations. Certainly in other parts of Australia, the work has been undertaken, in the main, by voluntary organizations and charitably minded people. Such organizations and persons have willingly given their very best so that the nursing services which the community so greatly required could be supplied. No praise is too high to give to people who, in that way, give of their best to the community. The sickness in the community, and particularly the sickness or invalidity amongst the aged, are matters- of great concern, and have always been matters of great concern; but with the growing span of life they have become matters of even greater concern."

It has been pointed out in the course of this debate that a great shortage of hospitals exists in the community and that the cost of building hospitals is becoming tremendous. The cost of hospitalization is very great, and very often is far beyond the means- of the ordinary person. In the course of the debate, the question was raised whether hospitals could be built and maintained' more cheaply than is the case at the present time. It would be a great mistake to think that we could have hospitals built cheaply but built in such a way that they would not enable proper care and attention to be given to the sick. The fact that hospitals are expensive to-day is simply part of what has been happening generally in the community. It is part of the rising cost of living and1 expenses, which have grown greatly over the years. A hospital becomes necessarily more expensive with all the additional scientific knowledge of to-day. Whereas in the old days a person who was ill would receive some sort of simple treatment, today a great many processes have to be followed, and a great many tests made, in order to ensure that the patient receives the right treatment. A hospital must have available to it the necessary equipment to enable the required tests to be carried out. lt has been said that medical science is progressing at such a rate that by the time a hospital has been built it is out of date. That may, ot course, be regarded as an exaggeration, but it shows the speed with which medical knowledge is increasing. Hospitals must be constantly acquiring new equipment and adopting new techniques. If persons cannot be admitted to hospital, cither because no beds are available' or the expense is too great, some form of home treatment must be provided. With that requirement in mind, the Minister has introduced this bill.

The idea of having district nurses visiting patients in their homes is, of course, not a new one. As I have already said, certain organizations have been carrying out this work for a number of years. The district nurses can give treatment that is of great value from a number of points of view. It is of value not merely because of the simple fact that treatment is given, but because the patients are treated in their own homes, with all the comforts that they are used to. A sick person greatly appreciates being treated in his own home rather than in a hospital or similar institution. He has the familiar surroundings of his home and the company of his dear ones. He is as comfortable as he possibly can be, having regard to the fact that he is ill. He derives psychological benefits from being treated in his own home.

Another advantage associated with home treatment is that the patient can be visited by his own local doctor. In the old days we often saw long queues of elderly people standing in the cold outside the out-patients' departments of hospitals. That practice is, fortunately, becoming a thing of the past. Legislation of the kind before the House is designed to provide elderly persons with proper treatment in their own homes. If a patient eventually is forced to go to a hospital, or if his admission to a hospital is delayed because of the shortage of beds, he has had the advantage in the meantime of treatment in his home.

Besides giving the usual treatment for illnesses, a home nurse can give advice on matters relating to nutrition, diet, and related subjects. Most of the people over 60 years of age, to whom the Minister has referred, do not require to have a nurse constantly at their bedsides. It is often sufficient to give treatment for half an hour a day, or, perhaps, a couple of times during the day. In some cases it is not necessary to give treatment every day. Treatment of some kind is, however, required, although hospitalization is not necessary. If such a patient can be treated at home, a hospital bed is thereby made available for a more urgent case. As I have mentioned previously, the cost to a patient of home treatment is very small indeed, when compared with the tremendous cost of treatment in hospital.

Something has been said in this debate about the medical profession. As a general rule, the doctor who will attend a patient in his own home will be a general practitioner. The cases that will be treated at home may be generally described as chronic cases. They will not require the attention of a specialist. However, I do not propose to be drawn into an argument on the question of whether a general practitioner to-day is less capable than was a general practitioner 30 years ago. It is true that nowadays more doctors specialize, but that fact does not appear to me to show that the general practitioner to-day is less capable than was the general practitioner of 30 years ago. That, however, is a matter of opinion. In my experience, the members of the medical profession carry out their duties with a high degree oskill, and the fact that some specialize and some practice generally does not alter the fact that each of them is able to exercise great skill in his own sphere. To-day there are many medical clinics at which four or five doctors practice. Very often those clinics include general practitioners and specialists, who work side by side. The patient who is treated at home can then receive attention from general practitioners or specialists from nearby clinics, as well as from the district nurse.

The sick persons to whom 1 particularly refer are those who are chronically ill. A great many old people are in this category. Those who have had experience of hospital management have found that it is impossible to keep a chronically sick person in a hospital for any great length of time. Because of the shortage of hospital beds, patients are discharged much earlier than they used to be, and there is no place in most hospitals for persons suffering from chronic illness. For the future treatment of such persons we must look to the district nurse and the local doctor, who can visit the patient in his home.

I believe that this bill will be shown to be of increasing value as time goes by, because the nursing organizations will greatly expand, and treatment will be available for many more chronically ill persons in their own homes. One of the problems confronting the community over recent years has been the shortage of nurses. It may be suggested that this shortage will show up a weakness iti the present measure, but the answer to that suggestion, I believe, is that the home-nursing organization will be able to employ nurses part-time. Many nurses who have married, or who are now elderly, are still capable of doing a certain amount of work each day, and those nurses who, for various reasons, cannot accept full-time employment, will be prepared to undertake part-time employment with the home-nursing organizations. Instead of working for the usual eight hours a day, or whatever it is, they may work four hours or three hours a day. But they will expand the pool of employable labour, and thereby to a great extent relieve the shortage of nurses that affect these organizations if they had to employ full-time nurses. Nursing is a vocation, and those who are attracted to it generally remain in it for life. However, various events in life take nurses away from their calling. This bill may give them the opportunity to go back to it for part of their time and to help in the magnificent work which is being done by homenursing services. It is a fine thing that the home-nursing organizations are to be given the opportunity to expand in this way. It is an excellent thing from their point of view, and it is something which they deserve to give them a fillip to continue the magnificent work they have done in the past. But what is much more important is that the aged sick in the community will be able to obtain much better care.







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