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Wednesday, 10 October 1956


That the bill be now read a second time.

The object of this bill is to authorize financial assistance by the Commonwealth to approved organizations engaged in the conduct of home-nursing services. The national health service is based on certain principles. One of the most important is the idea of a partnership - of co-operation between patient and doctor. Implicit in this is the realization that a powerful factor in recovery from illness and restoration to health is the sense of personal responsibility of the patient for what happens to him.

This means that the foundation of :. national health scheme should be an efficient and competent general practitioner service The importance of domiciliary medicine can hardly be over-estimated. A hospital service can never be a true substitute for the family doctor, whose role is becoming more, instead of less, important with the recent developments in medical knowledge. The modern general practitioner has powerful weapons in his hands, such things, foi example, as the sulphonamides and the antibiotics. and if his own standard of work r.mi knowledge is high, can undertake in ihe home, r.nd in full and proper collaboration with the specialist, a great deal of treatment to the great benefit of his patients in particular, and the country in general.

Much is said nowadays about the question of medical and hospital benefits, and all sorts of claims are made that these should be higher or more extensive. Whether this is so or not, the thing of fundamental importance is the quality of medical care, and it is essential that there must be not only no deterioration of the standard of family and general practice from the high level at which it has existed in the past, hut that this standard should be maintained and, if possible, raised. if this is so, then several things are neces sary. Not only is there need for good training of general practitioners, but the conditions of general practice must be such as to give scope to men who possess good training, and ability, and be designed to allow their patients to benefit from it to the full. This means in modern medical practice that trained assistance, by a complementary service, namely the nursing profesion, should be available.

For more than 50 years home nursing care has been provided for the poor and needy throughout Australia by district and bush nursing associations and religious organizations. Honorable members will be familiar with the charitable and public-spirited work of these bodies whose efforts have brought relief to the sick and aged, particularly in the poorer areas of the cities. The nurses employed by these home-nursing organizations are generally known in Australia as " district " nurses. The special feature of their work is that it is carried out by visits to the homes of the patients as distinct from hospital, clinic, or institutional care, or the services rendered by a nurse engaged privately by the patient.

The district nurses are generally referred to the patients, in the first instance, by a hospital or by a local doctor. The majority of patients nursed are those with long-term illnesses such as patients suffering from cardiac disease, arthritis, incurable carcinoma, and so on. Many of these patients ure very ill and would be transferred to hospitals or other institutions but for the serious shortage of hospital beds. The nursing these patients require is mainly general care, sponging, supervision, and general nursing treatment which is always arduous and time-consuming, though there are many cases which do not require more than a daily visit, or perhaps a visit several times a week.

Although chronic illnesses are prevalent among all age groups, they mainly affect people over 60 years of age. It is these people that make up the majority of the district nurses' patients. It is estimated that approximately three-quarters of the patients of each district nursing association are chronically ill and over the age of 60 years. A considerable amount of homenursing work is also done for patients who cannot be classified as chronically ill. but who require prolonged care, such as those requiring after-care for unhealed wounds following operations. At the same time, under modern conditions, an increasing number of acute cases is becoming suitable for treatment at home.

Since the war, it has been impossible for hospital construction to be maintained at a rate in any way commensurate with the growth in population. Consequently, it has become necessary for surgical and acutely ill cases to be discharged from hospital at the earliest possible time, whilst the chronically and less acutely ill have found it progressively more difficult to obtain hospital accommodation at all. Many of these chronically ill people, who in other days would have been hospital cases, cannot now receive the nursing attention they require unless they are visited by the district nurses. Because of this oppressive shortage of hospital beds, the need for adequate properly equipped home-nursing services has greatly intensified in recent years.

At the present time, some 150 district nurses are employed by home-nursing associations. A work analysis recently made indicates that each of these 150 nurses is at present saving the provision of six hospital beds; that is, the home-nursing services are saving 900 hospital beds throughout Australia. The capital cost of providing new hospital accommodation has risen to extraordinary heights. In the case of hospitals recently completed, the cost is reckoned at at least £7,000 a bed. The cost of maintaining a hospital bed has also reached a new and very high level. It is now rarely, if ever, less than £3 a day, and in the case of many individual hospitals is considerably more than that. By way of contrast, the cost of a visit to a home by a district nurse averages something like 7s.

These figures give some indication of the savings of very great significance to the community that are to be made by encouraging home-nursing for the sick, instead of hospitalization, whenever it is possible, lt has been reliably estimated that the maintenance of 150 nurses in district nursing work keeps hospital running costs down by at least £1,000,000 a year. The total cost of keeping these 150 nurses in the field is less than one-fifth of that sum.

Can I give the House a further example? If in a few years' time home-nursing were to expand to four times its present level there would be, on these considerations, a saving of 3,600 beds, resulting in the following financial savings: -


The cost of home-nursing services to produce such a result would be very small indeed. These are, of course, theoretical figures, but they indicate the magnitude of the financial relief which could be afforded to the general problem of hospital costs, in an expanding population.

These, in brief, are the financial and practical considerations in favour of the development of home-nursing services. At the same time it is realized that many patients, particularly old people, will be much happier and perhaps will be better, if they can be nursed at home, and modern medical thought favours this practice. Furthermore, it is now realized that the visiting nurse, can do much effective work in the field of preventive medicine, giving instruction in general health, nutrition, food habits, &c. lt is advantages of this kind which Australian and overseas authorities are now coming to recognize in the practice of sending the nurse into the home, instead of sending the patient into hospital. In view of these developments, the Government recently decided that the building up of numerically stronger and better equipped organizations of district nurses should be encouraged, so far as it is practicable for the Commonwealth to do so. The voluntary organizations already in the field have done splendid work. They have kept their services going when times were difficult and have accepted heavy financial burdens in an effort to expand their services in recent times to keep pace with growing public demands. We, therefore, believe that the most promising approach to the expansion of home-nursing services is to provide financial assistance for public and religious organizations qualified to perform this work. As the Commonwealth is entering this field for the first time, we felt it inadvisable to specify in this bill precise terms and conditions on which Commonwealth financial assistance will be made available. These matters will be determined according to circumstances affecting particular organizations and, perhaps, varied from time to time in the light of experience.

In general terms, the Commonwealth's policy will be to grant to non-profit making home-nursing organizations now in the field subsidies approximating the salaries paid to nursing sisters employed by them over and above the number ordinarily employed during the year prior to the commencement of the act. Thus, if an organization has ordinarily employed, say, ten nurses during the past year and increases its staff !o twelve nurses when this scheme commences, it will receive a subsidy approximating the salary of the two additional nurses: if it increases its staff to fifteen nurses lt will receive a subsidy approximating the salary of the five additional nurses. This basis for calculating the subsidy will be applied in relation to the organizations which are conducting home-nursing services at the present time. It is possible, of course, that new organizations will enter the field. It will be evident to honorable member*, that it will not be practicable to subsidize these " new " organizations on exactly the same basis as that proposed for the existing organizations, because that would involve the payment of a Commonwealth subsidy equal to the full salary of even nurse employed by each " new " organization. This would put " new " organizations on a much more favorable basis than those that have pioneered this field. It is proposed, therefore, that the organizations which commence home-nursing services after this act comes into operation will be entitled to apply for a subsidy equal to approximately half the salary paid to each nurse employed on home-nursing duty. This, I think, is a fair and equitable basis for handling this problem.

Up to the present, finance for the district nursing associations' work has come mainly from State government subsidies, collections from patients, and donations by the public. We think it right that money should continue to be supplied to the associations from these sources. The work of the district nurses results in a significant saving in State hospital expenditure, and the States, as I have pointed out already, support organizations engaged in this work. This bill provides that the subsidy to be paid by the Commonwealth is not in any case to exceed the State government subsidy. Naturally it is proposed to consult with the State governments about the effective carrying out of the provisions of the bill. The Minister's approval will be required before an organization is granted a subsidy under this scheme. The organizations which are granted subsidies will, of course, have to supply the Director-General of Health with adequate information and properly audited accounts and reports. For example, the Director-General of Health will in all cases have to be satisfied that the nurses on account of whom the subsidy is claimed are properly qualified. At the same time.I assure the House that the department will not be seeking to impose conditions or restrictions which will hamper the organisations in their conduct of their work. There will be no attempt by the Government to interfere with the organizations." management and control of their affairs except insofar as is consistent with the proper expenditure of public funds.I believe that this measure will prove to be of very great importance and value in the field of public health. I, therefore, hope that all members will be sympathetic to its objectives and will accord it their full support.

Debate (on motion by Mr. Chambers) adjourned.

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