FIRST INTERNATIONAL CONGRESS ON DOMICILIARY
NURSING
Melbourne, Victoria 2 FEBRUARY 1970
Speech by the Prime Minister, Mr. John Gorton
Madam President, Distinguished Guests, Ladies and Gentlemen:
Thank you very much for your welcome, Madam
President. My wife and I are glad indeed to be with you on this
occasion and to have the opportunity of extending, on behalf of
the Commonwealth Government, a welcome to all delegates, but
particularly, perhaps to those delegates who have come from overseas.
It is good that we have with us today delegates from
the World Health Organisation, from the North American continent,
from Europe, from Asia and from the Pacific. I take some small
personal satisfaction in having made the conference arrangements
a little easier, due largely to the persistence of Dame Ivy Wedgwood.
I wish at the beginning to pay tribute to the organisers
of this Conference, the Ff. rst International Domiciliary Nursing
Conference the Royal D ',. xrict Nursing Service of Melbourne.
Beginning in 1885 with a. si-aff of two nurses, they are now
recognised as the senior home nursing service in Australia, and
the conference owes much to their initiative and hard work.
But they are not the only organisation in Australia.
Twelve years ago, when the Commonwealth Government first
began to financially assist these organisations, there were some
19 organisations employing some 200 nurses. Now there are 78
organisations employing more than 700 nurses, engaged in
succouring the ill, in rehabilitation and in after-care throughout
Australia. You have chosen as the theme of this conference
" Domiciliary nursing in a Changing World". What is the nature of
this change referred to, as far as it concerns the matters you are
going to discuss? Over the last two decades there have been
great advances in the methods of treatment of the ill. and in the
technical ability to heal. But in this period there has also been
what is perhaps a more important change a determination on the
part of nations to see that this technical capacity to heal is applied
to the individual, to see that schemes are brought into being in
countries of the world whereby these new methods of medical and
hospital care are made available to all individuals in a community
and that none is debarred from sharing in them as a result of his
financial sit uat ion. This is indeed a great change, and perhaps what
you had in mind. But it is not an easy matter to arrange. What do we
want as a result of applying our minds to this change in attitude
towards our citizens? We want a scheme which covers the great
bulk of the cost of minor and major illnesses to a patient, whether
that cost be incurred by medical attention, hospitalisation or by
other methods of care and rehabilitation. We want a scheme which
requires some contribution from the individual, high enough to
impress on his mind that these matters are extremely costly, and
yet low enough t o ensure that all can join in the protection offered.
We want a scheme that is efficient from the point of
view of the patient, to whom we direct our attention. And we want
one which costs the tax payer as little as possible, consistent with
the effective operation of the scheme, and consistent with it being
extended to all our citizens. So this is what we want. Not very
difficult to state, but quite difficult to attain.
So we need to cover medical diagnosis and treatment,
hospitalisation and the other cares of which I have spoken. This
involves great and growing costs to the community, as
experience has shown in our country and every other country
which has involved itself in matters of this kind. This is true
whether the method of a scheme adopted is a compulsory one or
a voluntary one. In either case, there are great and growing costs.
Major problems leading to this cost, ones that we must
seek to guard against, I think, are unchecked rises in medical fees by
doctors, rising hospital costs as costs rise generally through the
community, the over-use by patients of medical or hospital facilities,
and the over-treatment by some doctors of patients who will add to
the income of the doctors tdu t over-treat them. I emphasise SOME
doctors. These are problems common to all schemes, again
whether they be compulsory or whether they be voluntary, and
overcoming these is a major matter for all those who wish to see
the proper operation of the health scheme I postulated at the
beginning, working in our community.
But in any case, even if we do overcome them, costs
will still tend to rise. They will rise because of the cost per bed
in hospitals. Perhaps this gathering might devote some of its attention
to seeing whether the cost per bed in hospital is necessary at its present
level, whether perhaps some of the stainless steel, some of the bronze
some of the general what sball I call it the general greatness
which is put into the building of hospitals is essential for the care of
the patient. There is a great field to be covered in hospital
construction, and in what is required for different classes of patients
in hospitals. In any case, this is just, in passing, one aspect which
this gathering may perhaps wish to take into consideration.
Perhaps more directly concerning this gathering is that
home nursing contributes to keeping down the cost of treating
patients in hospitals or even in nursing homes. Yet it does, of
course, far more than merely keep down the cost of treating patients.
It pays attention to the inner desires of someone I referred to hitherto
as a patient, but who is more than a patient, who is a living, sentient
human being. It pays attention to the scial and emotional desire of
such people to be treated in surroundings they know, in the company
of families they love, in their own homes. So it does far more than
merely keep down costs. It contributes very greatly to actual
healing, if actual healing is helped, as I believe it is, by the state
of mind of the person being treated, and this is the great significance
of this movement. There is another matter I would ask you to consider.
As the technical capacity to treat those who are ill has increased,
so there seems to have been an increase in the amount of training
and the number of certificates required by nurses. And I am sure
this is right and proper. But I wonder if all those nurses who make
home visits for domiciliary care need to be quite as highly technically
trained as some other nurses involved in hospitals perhaps need to be.
I am told by doctor friends ;-and I have some doctor friends
I am told by doctor friends that in many of these cases what patients
at home need more than anything is what they describe as TLC or
tender loving care, which involves the smoothing of a pillow, the
makcing of a bed, the bringing of a cold drink, the talk about little
matters of the day, the provision of a hot water bottle which in
themselves, the laymen would think, did not really require triple
certificates in order to be able to be devoted to the welfare of the
patient. But I just put this question to you and look to you for the
answers to it to come back in due course.
I am sure the answer to that and other questions of
significance will emerge from this Conference and will be of help
to me, and to the Parliament and to the nation, for on these matters
we will in the year ahead be hearing a very great deal indeed, and be
seeking to make advances in solving some of the problems involved.
It is of some help and some sustenance to those who try to devote our
attention to this to know that here in Melbourne, and in Australia today,
4.
we have this conference concerned in the same affairs, preparing to
devote its discussion to those affairs, and we know that out of that
discussion there will be help for us in our attempts to be, as it were,
the midwife between the Australian nation and those who are sick in
the Australian nation, so that what the Australian nation wants to do
for those who are sick, we may help them do in the most effective and
efficient way possible.
I must finish by congratulating and thanking all of you
for having devoted your attention to the thought and care for
those who are less fortunate than you. That in itself will, I think,
be a reward for you to know you have done that, but a rather more
concrete and rather more significant reward will be if from this
Conference there emerges proposals which a government is able
to consider and perhaps adopt for the good of the people of this
nation.