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Thursday, 4 April 1968

Mr DEPUTY SPEAKER -Order! The Minister will address the Chair.

Dr FORBES - I am putting the editorial opinion of that newspaper in its proper context by making the remarks that I am making. I can understand the point of view put by the honourable member for the Australian Capital Territory. I respect it. I should like to make it quite clear that I do believe that what should happen in Canberra in relation to self-government and local government is one thing and that running a hospital is another thing. I do not believe that it is a valid argument to say that, because the people of Canberra have more limited opportunities than they perhaps think they should have in an overall local government sense, they should not be deprived therefore, if there are good reasons, of the right to elect people and particularly the majority of members of the Canberra Community Hospital Management Board.

Why was this decision taken? The honourable member for the Australian Capital Territory talked about the people of Canberra being deprived of a right that they had had running back into the 1930s. But he did not tell us that the reason why the people of Canberra originally were given that right was that in those days, when this system was first introduced, the people of Canberra paid a direct hospital tax and, in the context of no taxation without representation, this system was devised. Obviously, it was appropriate in that situation in which the Canberra Community Hospital was little more than a cottage hospital. That situation has not existed now for 25 years. The people of Canberra have not paid this direct hospital tax in that time. In the meantime, the Canberra Community Hospital has grown from a small cottage hospital to a complex which will soon be a 600-bed general hospital, the equal of any hospital in Australia. I think that the honourable gentleman must admit that that represents a changed situation. It is one of the contexts in which this decision was made.

Another reason is that the decision was taken by the Government to develop a multi-hospital system in Canberra. Decisions were taken to build the Woden Hospital and to subsidise the Calvary Hospital to be built by the Little Company of Mary. Despite what the honourable gentleman has said, this very fact has been explained to the public many times. We must have a good hard look at the overall control of individual hospitals and the whole hospital system in Canberra. One thing we run up against when we have more than one hospital with direct representation is the mechanical problem of what part of the Canberra community elects people to a particular hospital? Do we zone the ACT and associate one part of Canberra with one hospital and another part with another hospital? Or do we hold a great big election for all the hospitals and then apportion the elected members out between the hospitals?

I was very much opposed to the idea of zoning. We do not propose to zone hospitals in Canberra in respect of the admission of patients. The hospitals will be integrated. They will have integrated services. Some hospitals will do certain things and other hospitals will do other things. All of them collectively will service the whole of the people of Canberra. Of course, that system would have been frustrated, to a large extent, by zoning or introducing electoral boundaries or something of that nature for the election of members to the various hospital boards. But this was not the main reason for adopting the course which we took. The people in Australia who have the greatest experience in this field and who know most about this matter are the people in the States. They run a large number of hospitals of the size of the Canberra Community Hospital. Their experience is much greater than ours.

We looked around Australia and sought the guidance of people who run the State hospital systems. We found that in every State, with the possible exception of Victoria, the current and almost universal practice was to have nominated hospital boards, not boards directly elected by the people. I go so far as to say that that is the case even in Victoria where boards are elected by contributor representatives, but since the introduction of the national health scheme that procedure has become purely formal, and in every sense of the word it could be said that even in Victoria there are nominated hospital boards. It would have been very difficult to go against that experience. The hospital authorities and State governments which for many years have been running hospitals of the size of the Canberra Community Hospital have found, gradually by experience, that the best and most efficient way to run a modern and complex hospital is by having a nominated board. This fact, together with our intention to introduce a multi-hospital system to Canberra, went a long way towards the Government deciding that we should change the present system in Canberra.

The additional factor, as the honourable member for the Australian, Capital Territory himself has acknowledged - at least in part - is that the taxpayers pay a very large part of the cost of running the Canberra Community Hospital. From memory I think they pay more than 70% of the cost. Therefore I believe that the taxpayer's representative - in this case the Government - should have a predominant say in running the hospital. This was not the case under the old system. Perhaps I should comment on the reason why the States have come to the conclusion that having nominated boards is the best way to run a hospital. We have received evidence everywhere on this point. The function of a hospital board is to see that the hospital is conducted effectively, with proper regard for the interests of the patients, the medical profession and the hospital staff and with due regard to economy. With the complexity of modem hospital administration there is a need to select people who have practical experience in hospital administration or in the control of large undertakings. Although, as the honourable member said - and I fully acknowledge this - we got very good people under the old system, they did not all have that particular qualification which I believe is absolutely essential in the conduct of a hospital such as the Canberra Community Hospital has now become and as the Woden Valley Hospital will become. Perhaps this matter was not quite so important in the days when the old system was first introduced.

I do not wish to say a great deal more on this matter. The honourable member for the Australian Capital Territory said that my colleague the then Minister for the Interior, now the Minister for Primary Industry (Mr Anthony), obviously was not consulted regarding these changes. The then Minister for the Interior was consulted and was in full agreement with the changes. Of course, he was a party to the decision taken by the Government. Perhaps I should make two further comments in relation to the points raised by the honourable member for the Australian Capital Territory. He said that in his view it was improper for the two elected members of the ACT Advisory Council, who now serve on the Hospital Board, to be chosen by the ACT Advisory Council. The honourable member suggested that this could lead to a had result because it was conceivable that the nominated members could be given directions as to the way in which they were to vote. There are two points I should like to make in this respect. I say now, as I have said previously - and I have checked this with my colleagues from whose departments other nominations come - that no direction was given in this case or ever has been given in relation to the way in which nominated members will vote. The other point I make is that the ACT Advisory Council nominates representatives not only to the Hospital Board but also to a host of other institutions. There is the ACT Electricity Authority and a number of other undertakings which do not readily come to mind. It seems to me that we cannot differentiate between these undertakings. If that is the system for nominating representatives, it should apply to the hospital in the same way as it applies to other undertakings. If it is desired to alter that system it should be looked at as a whole and not related to something which applies particularly to the hospital.

Finally, I think that the test is in the way things have worked out. The new system has proved to be very satisfactory. The Canberra Community Hospital is run efficiently and extremely well. I am not conscious of any suggestions that the new Hospital Board has in some way overridden the interests and rights of the people of Canberra, that there is not a constant channel of communication between the people of Canberra and members of the Board, and that the members of the Board are not conscious of the necessity for keeping in touch with the needs and interests of the people of Canberra. Indeed, a large part of the correspondence which reaches my desk from the Canberra Community Hospital suggests that the contrary is the case; that the members of the Board have these interests very much at heart and that in the process of running this fine and complex institution they are constantly attempting to keep in touch, deliberately and directly, with the needs of the people of Canberra. I ask the House to reject the motion.

Question put:

That the motion (Mr J. R. Fraser's) be agreed to.

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