With District Health Boards in the red is it time to call a duck a duck and start reform?
September 23, 2018
The figures released over the weekend when it comes to our District Health Boards being in deficit makes for stark reading for many New Zealanders and begs the question is it time for additional reform and to look at the model itself? The Minister, David Clark, has a tough job ahead of him and some would even suggest that Health is the portfolio that you try and run from.
The challenge is made greater when you realise just how much the systems was neglected and under invested in by the previous Government and its Minister, Jonathan Coleman. Lets first take a look at the figures: the total deficit is estimated at $239.5 million with only four DHBs running in the black; Auckland, South Canterbury, Nelson Marlborough and Waitemata. Even then the break-even points are relatively small and could quite easily run red with the slightest change in unforeseen expenditure. Canterbury and Waikato alone account for just over $100 million in deficits at a time that more and more New Zealanders are entering a systems under pressure. From urgent maintenance and repairs to operation waiting lists for major surgery the time has come for an honest discussion about whether or not more gain can come from reform of the DHB model itself. The DHB journey began decades ago at a time when it was fashionable amongst Government to trial new business models. It was the era of the Regional Health Enterprises and Crown Health Enterprises.
Now, the Government can be forgiven for wanting to touch the model being a creature of its own creation under former administration but when the system is this sick you sometimes have to made bold decisions about the cure.
The other pressure coming on the system is the increasing demand around mental health services. As more and more New Zealanders feel its ok to seek help, as we run national campaigns that encourage it the truth is we don’t have nearly enough supply of workforce to meet demand. And; when it comes to the many people who are sectioned under the Mental Health Act into a system with few beds the situation is only going to get worst. Of course there is the reality of the structure of the current model – consider this for a moment. We have more than twenty District Health Boards. At the top of each sits a board, off to the sides are any number of advisory groups, committees and groups. Then there is a CEO and executive management team and below them come line management, operations and administration. That’s before we even get to the actual nurses, doctors and clinical staff that treat people supported by the army of workers who clean the beds and wards, feed and cook for the patients and care for them. Now, multiple all of that by more than twenty and ask yourself the question is this the right model for a nation of less than 5 million people in a country that isn’t that large geographically?
There is an old episode of that British classic called “Yes Minister” where fictional Minister of Administrative Services, Jim Hacker, asks about a new hospital that has been built but not yet opened.
He visits the hospital only to find that there are no patients, doctors or nurses – yet there are hundreds of administrative workers. The Chief Administrative gleefully gives him a tour and says that without the immense number of administrative workers the hospital wouldn’t be what it is – award winning. Hacker could not believe his eyes and ears …
At the moment we are tinkering around the edges of trying to put to put a band aid on a broken leg with some mistaken belief that somehow it will correct itself. We should not be afraid to be bold and look at reform and what a new co-design model of health in New Zealand might look like. Its not just about the money its about whether we can develop and build a new model that will serve New Zealanders into the next few decades and Minister Clark has the chance to do something the previous Minister didn’t have the guts to do. Former Minister Coleman was great at doing much a do about nothing.
About the author: Matthew Tukaki is the Chair of Suicide Prevention Australia, former Chair of Deakin University CSaRO and Australia’s Representative to the United Nations Global Compact. Matthew is currently Chair of New Zealand Maori Council, Auckland District, Chair of the National Maori Authority, a Member of New Zealand Maori Council, Chair of NewsNow and Managing Director of Babana Aboriginal.
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