By the late 20th century hospital services had become fragmented and expensive. Hospitals were managed regionally and central governments struggled to control costs. From the 1970s many maternity hospitals in rural and urban areas were closed. Their services were absorbed by large general hospitals.
In 1998 the Alliance Party planted 54 white crosses on the lawn of the Stratford Hospital in Taranaki, which closed the same year. The crosses represented hospitals that had closed between 1984 and 1998. Party member and Parliamentary candidate Kevin Campbell said, ‘[W]e’re talking about the slow death of our public health system and this is a way to really show people what’s happening.’1
In the 1990s major reforms to the health sector by the government led to the closure or downsizing of many general hospitals, particularly smaller ones in rural areas. Local communities fought against many closures, usually unsuccessfully.
By the 21st century hospitals were generally located in the larger towns and cities. Some smaller towns had district and community health centres with more limited services.
Criticism of hospitals
By the 1970s, when health technologies and medical knowledge had dramatically expanded, hospitals and medicine in general were widely criticised by members of the public and community health groups in New Zealand and elsewhere. This can be linked to the anti-authoritarian mood of the time, and campaigns around civil rights, consumer rights and women’s health.
Health advocates argued that the clinical nature of hospitals and the medical research conducted there made patients invisible and vulnerable. Others criticised the ever-increasing costs of hospitals, citing research which showed that modern therapeutic developments had played an insignificant role in the increase in life expectancy over the past 200 years. The effectiveness and the ethics of modern medicine, or the ‘medical model’, were questioned.
In New Zealand criticism of medicine and hospital-based healthcare came to a head with the Cartwright Inquiry (1987–1988). The inquiry, headed by Judge Silvia Cartwright, investigated allegations concerning the treatment of cervical cancer at National Women’s Hospital in Auckland. Cartwright concluded that treatment of some of these women was inadequate and that ‘for a minority of the women, their management resulted in persisting disease, the development of invasive cancer and, in some cases, death’.2
Controversy relating to the treatment of women for pre-cervical cancer at National Women's Hospital continued in the years following the inquiry. Whilst some commentators have continued to assert that Associate Professor Herbert Green’s management of cases of carcinoma in situ of the cervix caused harm, others have argued that a watch-and-wait approach was an appropriate response to positive cervical smears and that Green followed international best practice.
Women’s and health activists were particularly critical of the medical profession in the 1970s and 1980s. In its submission to the Cartwright Inquiry, the New Zealand Women’s Heath Network said it was their view, ‘that in general the New Zealand Medical Profession displays sexist attitudes and racist attitudes towards its patients.’3
The inquiry reflected its time and contributed to social change in medicine. In particular it signalled a lack of public trust in doctors and reflected a transformation of doctor–patient relationships, which was also occurring in other Western countries, as they moved from a paternalistic to more democratic relationship. As part of this process, consumers gained more power in the hospital setting and in medical decision making.
Health and Disability Commissioner
The Cartwright report recommended that an independent commission be established to uphold and promote the rights of health consumers. The first commissioner was appointed in 1994. The Code of Health and Disability Services Consumers' Rights, which sets out a number of specific rights and provider duties, became law in 1996.
Changing role of health practitioners
The role of nurses changed in the late 20th century. From the 1970s nurses were trained in tertiary institutions, and considered themselves professionals in their own right, rather than simply doctors’ assistants. From the 1980s hospitals were administered by non-medical managers and doctors had less input into how they were run.