ASMS

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Health investment should be determined by need not number-crunching

31 August 2020 ASMS comment piece

The crisis which has been playing out at the Canterbury DHB is in many ways a cautionary tale and if we do not take lessons from it, it will be the first of several large dominoes to fall. DHBs should not have to push austerity to reduce debt.  Read our opinion piece as published in the Sunday Star Times.

In the space of a week we have seen two protests outside the Canterbury District Health Board.  It takes a lot for doctors, nurses, and health staff to speak out like that and they do not do it lightly.  Not only does it attest to the fact that something is very, very wrong, but that DHB staff feel passionate about the system they work in and ensuring the people of Canterbury get the health care they deserve.

It’s also been painful for them to watch the DHB spiral into an unprecedented leadership crisis in which the actions of the Board and the government-appointed Crown Monitor, have put senior leaders in an untenable position.  Seven of eleven top executives have resigned, including Chief Executive David Meates.

The real shame in that is David Meates and his team have overseen an enviable model of collaboration between management and clinicians, producing one of the most efficient, productive, and innovative DHB systems in the country.

However, the DHB has been under immense pressure to reduce the size of its deficit which is the largest in the country, mainly due to ongoing quake rebuild costs.

Its financial woes have been years in the making, and it is only reasonable they will take a while to sort it out. Some of them are the direct outcome of previous governments’ decisions to fund rebuilds through deficits. Some are the direct outcome of the delays to the completion of the new Hagley Building. Some are because we inflict a hefty penalty on DHBs when they run up infrastructure debt.

Add to that mix the Crown Monitor Dr Lester Levy and Board Chair Sir John Hansen, whose common interest is in cracking the financial whip.  Dr Levy believes we can all work smarter and save money from the public purse, while Sir John appears to see his primary responsibility as doing whatever the Minister of Health asks of him, rather than serving the health interests of the community. The Board has also had a disappointing penchant for doing its business behind closed doors.

The DHB’s leadership team thought they could sort the deficit within three years.  The Crown Monitor and the Board (whose members are far from united) insisted radical savings needed to be made – and fast. They wanted $90 million dollars of savings over the next year.  Reluctantly, management came up with proposals for savings of $56 million.

Despite saying savings would not negatively impact on hospital services, the Board has signed off on about $13 million worth of proposed cuts to nursing staffing and another $2 million targeting doctors. I cannot work out how cuts that significant will not affect services, especially when our own surveys tell us that there are existing shortages across the senior medical workforce and the highest priority concern for senior doctors right now is short staffing.  And all this during a Covid pandemic.

The crisis playing out at the Canterbury DHB is in many ways a cautionary tale and if we do not take lessons from it, it will be the first of several large dominoes to fall.

The Southern District Health Board could be next. It is in the process of trying to build a very expensive new hospital in Dunedin.  But the rebuild does not include mental health or digital health solutions and in the meantime Invercargill’s tired cramped hospital lacks enough points to make it onto the infrastructure waiting list. It is highly likely the DHB will be told something along the lines of ‘you’ve been given enough, sort out the patients and balance your books, or else’. The end result is that people in the region won’t get the health services they need.

Investment in health must be determined by need not number crunching.  DHBs should not have to push austerity to reduce debt and good leaders should not be forced to make choices they can’t live with.

New Zealand has faced decades of underfunding in health and the Government has made a start in trying to correct that, but if we’re really serious about wellbeing budgets and about being kind, then it’s time to have a fresh look at how we invest in our health.

It’s a message that the staff at Canterbury DHB are clearly willing to get behind.

-Sarah Dalton, ASMS Executive Director

Published Sunday Star Times August 30.