DHBs are a public good – let’s start treating them that way
Peter Davis makes a number of salient points about DHBs and public health in his opinion piece (‘Loss-making DHBs need a serious re-set’ Jan 9) and it was heartening to see a new board member from the country’s largest DHB speaking up.
His article stresses the need for DHBs to maximise the benefits they provide to the community – and rightly so. However he underplays the bare-faced reality of a public health system in which DHB running costs far outstrip funding levels. It’s a situation we can’t continue to ignore.
We know that New Zealand’s overall health spend as a proportion of GDP is low compared to the countries with established wellbeing approaches to social policy. That’s puzzling when it’s those countries and health systems which the current government aspires to. Also perplexing are hints out of the Simpson health review, which is due to report back in March, that it doesn’t think overall health funding is a problem.
Professor Davis points out that robbing Peter to pay Paul by stripping non-hospital services to prop up other parts of the health machine will not fix the engine. The answer is that we need bigger engines and they need to be properly and regularly serviced. He may not favour “staring down the government of the day to come up with a lot of new money”, but it certainly would be a fantastic first step.
We should all benefit from the public health dollar, and by “we” I mean all of us. Health equity is completely out of whack, with tangata whenua and Pasifika well back in the care statistics. The Counties Manukau DHB has tagged a senior leadership role with “funding and health equity”, while Auckland DHB CEO Ailsa Claire has promised to tackle institutional racism. It’s a start but we need to see more detail and be able to track progress on such initiatives.
There are a few other glitches in Professor Davis’ recipe for health. He asserts that hospital productivity is declining when there is clear evidence (Canterbury DHB, for example) that the opposite is true. Senior medical and dental staff are working harder and smarter than ever to deliver quality care to patients. Ask hospital specialists how they can deliver more day surgeries and they’ll tell you they’re already running at maximum. Similarly hospital wards are full to overflowing, yet hospitals are designed to run most efficiently at around 85% occupancy. For many of our large urban hospitals more than 100% occupancy is the depressing new normal. It’s the same for mental health in-patient units.
Taking a short byway, let’s reflect on Professor Davis’ question about “who is going to prevent young children taking up valuable hospital dental services”? Hospital dentists and anaesthetists spend hours of their working lives in operating theatres, putting small children to sleep and pulling out their teeth. How about a sugar tax, fluoridation and water-only schools? Such public health initiatives bring a massive cost benefit and improve the nation’s health. Central government should be taking the lead on this.
But back to the public hospital superhighway…
Our hospitals are riddled with poorly-designed, not fit-for-purpose health software which often doesn’t sync with existing hospital IT. Badgernet was a stellar example of this. Its only redeeming feature being its entertaining name.
My organisation is looking at research documenting how health IT systems negatively affect senior medical doctors and add to their stress and burnout levels. Why not, for our country of five million people, choose a decent system that works across the healthcare spectrum and give it to everybody? It’s worth a look.
The big thing Professor Davis gets right in his article is that “existing staff themselves often know where the obstacles to efficient work practices lie”. They certainly do. Stop running hospital specialists into the ground with under-staffing and insufficient resources. Ensure senior doctors have enough non-clinical time to lead planning, teach junior doctors, support nurses and allied staff and sit down with GP colleagues to plan for integrated care across hospitals and in the community. It’s not rocket science, but it needs real investment to deliver the kind of quality public health care that New Zealanders value and deserve.
Published in the NZ Herald 23 January 2020