The beginning of a hospital system may be said to date from the Colonial Hospitals built by Governor Sir George Grey in Auckland, New Plymouth, Wanganui, and Wellington. These hospitals were intended both for Maoris and Europeans, to be nursed in the same wards; in addition to the admission of Maori patients, many more were treated as outpatients.
The Auckland Hospital was a wooden building sited in the Domain. Building commenced in 1846 and patients were admitted before completion of the upper storey. It was criticised by the Colonial Surgeon, Dr W. Davies, in 1849, as being too far from the centre of the town, and without a satisfactory water supply, its well failing in dry weather. He also complained that wind and rain gained access to some of the wards, and that there were no adequate bathing facilities. The Wellington Hospital was built at Thorndon about the same time, and was admitting patients by September 1847. It was a two-storey brick building, and suffered considerable damage in the severe earthquake of 1848. It was replaced by a wooden building on the same site in 1855, and in 1881 a new hospital was erected on the Riddiford Street site where the hospital now stands. The first hospitals in Canterbury and Otago were built later, but by 1853 there was a hospital at Lyttelton, and the first Christchurch Hospital was built in 1862. The Dunedin Hospital was built in 1851, in the Octagon, and was transferred in 1865 to the Exhibition Building on the site of the present hospital in King Street.
The hospitals continued to be administered by the Government until 1854 when they were handed over to the Provincial Councils. From time to time as the need became apparent other hospitals were provided, being paid for as a rule by public subscription subsidised by Government funds. By 1884 there were 38 hospitals distributed throughout the country. With the abolition of provincial government in 1876, the Central Government resumed responsibility for the hospitals, and for the next 10 years they remained under the management of local committees with the Government bearing most of the cost. Successive governments sought for a solution of the hospital problem, but could reach no agreement with the local authorities as to the best method of controlling and financing them.
In 1880 Dr F. W. A. Skae was appointed as the first Inspector of Hospitals and Asylums, but died in the following year. He was followed by Dr G. W. Grabham, who had considerable knowledge of hospital administration. He was at first very critical of the condition of the hospitals and their administration, but his helpful advice was readily taken, and in his final report for the year 1886 he recorded very great improvement in most of the hospitals. His chief criticism was of their haphazard distribution, and of the extravagant method of financing them.
The first Hospitals and Charitable Institutions Act was passed in 1885 and set the pattern for our hospital system which in the main has continued up to the present. The country was divided into 28 hospital districts, each controlled by a board whose members were appointed annually by the local authorities of the district. The hospitals were to be financed by patients' fees, and, it was hoped, by voluntary contributions from the charitably minded, the balance being supplied by local rates with a Government subsidy. A number of “separate institutions”, which also received money from the rates as well as Government subsidies, continued in independent existence so that in effect there were two separate systems existing together. A new Act was passed in 1909 under which board members were to be elected by the electors of their district, and to hold office for three years. All the separate institutions which could not operate without assistance from the local ratepayers were taken over by the hospital boards, and the number of hospital districts was increased to 36.
By 1926, when the third major Hospitals Act was passed, the number of hospital districts had been still further increased, and the boards received approximately one-third of their income from patients' fees, one-third from local rates, and one-third as Government subsidy. The Act of 1926 remained in force for 31 years, by which time the method of financing the hospitals had undergone such great changes that the Hospitals Act 1957 became necessary. The introduction of hospital benefits under the Social Security Act 1938 relieved patients of the payment of fees, while in 1946 the maximum rate of hospital board levy on local authorities was stabilised at one halfpenny per pound of the rateable capital valuation. This was still further gradually reduced over a period extending from 1951 to 1957, by which time the hospital income from local rates was entirely abolished, and the Government became responsible for all public hospital finance.
During the thirties it also became evident that the continual subdivision of hospital districts had gone too far, and a trend developed for the amalgamation of districts in order to increase the efficiency of the service. A number of amalgamations has taken place, and while there were at one time 47 hospital districts, the number has now been reduced to 37. The Act contains machinery for a further reduction of districts.
The Hospitals Act 1957, as well as making the Hospital Works Committee a statutory committee, set up a Hospitals Advisory Committee of six members, three departmental and three from hospital boards, its function being to formulate a national hospital policy and to make recommendations to the Minister; and while local administration remains with the hospital boards, the Department, under the Minister, continues to be responsible for the general supervision and direction of hospitals, and all capital expenditure must be approved through the Department by the Minister.
The Present Hospital System
Today New Zealand is well supplied with modern hospitals distributed throughout the country in proportion to the population. In 1965, excluding mental hospitals, there were 74 general hospitals, 99 maternity hospitals, 22 special hospitals, 22 old people's homes, and three Government hospitals. The number of beds, at 31 March 1965, available for patients or inmates in all public institutions and licensed private hospitals, together with the ratio per 1,000 of population, is shown in the table.
The total staff employed in public hospitals and other institutions controlled by hospital boards at 31 March 1965 was 28,421, of whom the largest groups were:
|Medical practitioners (full time and part time)||1,668|
|Other professional and technical staff||2,266|
|Domestic staff, etc.||9,964|
|Other treatment staff||431|
Salary scales for the different grades of hospital employees are determined by a Salary Grading Committee so that uniform salary scales apply in all public hospitals.
Scope of Hospitals
The largest hospitals, at Auckland, Wellington, Christchurch, Hamilton, and Dunedin, in addition to the ordinary hospital services, are able to provide a wide range of specialist treatment which is available also to patients from other districts. Some seven or eight other hospitals of moderate size provide limited specialist services which are available to patients from nearby districts. All but the smallest hospitals are equipped with laboratories and diagnostic X-ray departments.
Method of Staffing
A few public hospitals are classed as closed hospitals—that is to say, the whole of the medical staff are full-time salaried officers of the board, but in the great majority of hospitals a large portion of the senior medical staff are part-time officers engaged also in private practice.
The larger hospitals have specialist outpatient departments in addition to the usual casualty department for surgical and other emergencies, but the attendance of outpatients seeking services that can be provided by the general private practitioner is discouraged.
Hospital boards are required to operate their own ambulance services unless they enter into some arrangement with a subsidised voluntary agency. In 1965 there were 229 road ambulances operating from 130 stations – 47 stations and 93 vehicles being operated by hospital boards, and the majority of the remainder by the Order of St. John.
Thirty-six aircraft were available as air ambulances, and are operated by aero clubs and private operators. Air-ambulance facilities are also provided when necessary by the National Airways Corporation and the Royal New Zealand Air Force.
The special hospitals under the control of hospital boards in 1965 included:
1 tuberculosis sanatorium.
5 convalescent hospitals.
22 hospitals for elderly people.
2 hospitals for cripples.
8 hospitals for non-acute conditions.
1 children's home.
In addition, a large number of maternity hospitals are maintained by hospital boards.
The Department administers three hospitals – the St. Helens Hospitals at Auckland and Wellington and the Queen Elizabeth Hospital, Rotorua.
The St. Helens Hospitals were established in 1907, and 1905, respectively, in accordance with the Midwives Act 1904, as State maternity hospitals for the training of midwives, which function they still perform. Queen Mary Hospital was established during the 1914–18 War for service patients and later turned over to civilian use. It has 117 beds and provides treatment for patients suffering from the neuroses. Queen Elizabeth Hospital, with 135 beds, provides treatment for rheumatic conditions, and includes a unit of 20 beds for children suffering from cerebral palsy.
Details of the private hospitals, with numbers of licensed beds, are shown in the following table. The figures give the position at 31 March 1965:
|Type of Hospital||Number of Hospitals||Number of Licensed Beds|
|Medical and surgical||42||971|
|Medical and children||6||286|
Private hospitals are governed by regulations which set out requirements as to staff and equipment. Each is licensed for a stated number of patients, and they are under regular inspection to ensure that a satisfactory service is maintained.
To encourage the establishment of private hospitals the Government has advanced loan money on easy terms to licensees for capital expenditure.
by Francis Sydney Maclean M.B., B.CHIR., M.D.(CAMB.), M.R.C.S.(ENG.), L.R.C.P.(LOND.), formerly Director of Public Hygiene, Department of Health.
- Appendices to the Journals of the House of Representatives, Department of Health Reports, 1939, 1958, 1960 (H. 31 of each year).