7 minute read
A new era dawns – what do members think?
ASMS members have a wide range of views about the upcoming health reforms. Senior communications advisor Eileen Goodwin spoke to some from different parts of the country.
It’s to be hoped the revamped health system replicates the successes of the better performing District Health Boards, rather than the poorest-performing, Wellington radiologist Arun George says. He’s speaking from the perspective of radiology, and, for Dr George, Canterbury stands out, both in IT and workforce planning. “Christchurch workforce planning has been exceptional for radiology.” “They are the only ones who have a surplus [of radiologists] now to send to the rest of the country.” But looked at in purely financial terms, Canterbury District Health Board is seen as a failure. It depends how success is measured, Dr George says. “Are we aiming to be like Canterbury, or are we aiming to bring down the Canterburys to where Wellington is?” “The one centre where they showed the rest of the country how to do it, their Board was punished. “It’s almost like a complete disconnect.” Dr George knows his view is unlikely to find favour in certain quarters, given the longrunning funding row between the Ministry of Health and the South Island board.
He says health care resources are simply not sufficient for the clinical demand after “many years of chronic underfunding”. Asked what he would, given the chance, tell the Health Minister: “I’d say come and listen to the people on the front line. Don’t start a conversation saying there are no resources”.
“That just means you are coming into some kind of conversation with conditions, so it’s not going to go anywhere.” Dr George says he has fought many times for additional resources by demonstrating need with hard data, but “it just keeps going in circles”. In Auckland, at Waitemata - District Health Board, Dr Jonathan Casement is also wary, saying he’s “neither for nor against” the shake-up. Dr Casement worries a populous area like the North Shore may lose out within metropolitan Auckland in a regional health authority. “Waitemata - District Health Board does well as it has a big population. When that population doesn’t matter because you’re in a region, I’m not sure how the allocation of resources across that region will take place.” Dr Casement hopes the new system ushers in a transparent ranking system for prioritising hospital builds. He says while any system can be “gamed”, there is realistic potential for improvement. He is sceptical of claims the system will end the postcode lottery, saying rural and sparsely populated areas will likely remain disadvantaged. He adds the shortage of doctors in rural areas persuaded him of the need for a third medical school. It’s too hard to get into medical training. “You don’t need people who are massively bright, you need people who are reasonably bright and work hard.” At Middlemore Hospital, Emergency Medicine Specialist Sylvia Boys says the reform’s goals, such as improving Ma -ori health, are commendable. She is also concerned about how the reforms will take shape. In practice, she points out, increased access to service could mean travelling to Auckland Hospital. Many patients cannot afford petrol or parking costs. “Whether patients benefit from the . . . amalgamation of services is not certain, and traditionally Auckland has tended to ‘win’ when this has happened.”
“South Auckland does have a different population than elsewhere in the country, we are a substantial Pacific community, losing the DHB structure means that the local knowledge of how to provide care to our unique communities may be lost.” “I am concerned that centralisation of services, while on paper cost saving and allowing equitable access, will in fact continue or worsen inequities.” She wants to see much more emphasis on addressing the drivers of health, such as poverty, housing, and food. There are industrial implications from having a single employer which will require strong union representation to ensure staff are not forced to accept substantial changes in renumeration, conditions or location of work. “There has possibly never been a more important time to be an ASMS member,” she says. On the West Coast, there are concerns about a change in the special relationship with the larger Canterbury DHB.
Dr Arun George Dr Sylvia Boys Dr Jonathan Casement
Dr Graham Roper, West Coast DHB’s chief medical officer, calls the reforms a “double-edged sword”, with the potential downside including losing some of the benefits of the Transalpine partnership with Canterbury. “We’ve established some really good links with Canterbury DHB, and if it devolves into being a broader provider, some of those links are not going to matter as much, and not be of benefit to our community.” The DHBs have a shared senior leadership team, and a handful of clinical services have merged and are working well between Canterbury and West Coast.
He would not like to see the isolated West Coast become a “forgotten outlier” in the new system.
On the flipside, there’s potential for developing a strong South Island-wide rural health network under the auspices of Health NZ. He says the DHB is developing a proposal for how the model could work to present to health officials. Dr Roper says he’s not sure what the Health Minister’s promise to do away with the so-called postcode lottery means in practice. “The fact we’re all going to be one big happy family won’t translate into more specialist surgical services operating on the West Coast.”
He muses that perhaps more West Coast patients will be funded to travel elsewhere for treatment, but capacity constraints in other centres made this uncertain.
And in Canterbury, it is fair to say there is trepidation. Dr Emma Jackson, Clinical Director of Obstetrics and Gynaecology at Canterbury DHB, hopes the new system will see all patients able to access communitybased treatments and clinically effective pathways that operate in some parts of the country, but not others. As an example, she cites community insertion of long-term reversible contraceptives. “Some DHBs, such as Canterbury, have been able to achieve high levels of funded community insertion, whilst other DHBs have not passed on the funding to provide subsidy for community insertion, relying on wahine to travel to a DHB-based clinic which limits many from attending.” DHBs also have differing policies about which women meet the funding criteria. “I would hope that the reforms standardise this and make the care and subsidy streamlined and nationally accessible for all, locally, in a culturally appropriate setting,” Dr Jackson says. Further south, in Dunedin, paediatrician Dr Liza Edmonds welcomes the reform as she says the current system is not meeting the needs of the community. “Although major change sounds daunting and a big job, sometimes to get actual change a major reform is what is needed.”
“If we do not have significant change the existing inequity that we see will be perpetuated, and this reform needs to hold the system to account for this and enable the advantages experienced by some to be experienced by all,” Dr Edmonds says. She says her patients – children – are more affected by inequity. It will be essential their voices are heard in the reform.
“It is challenging for child health voices to be heard amongst the larger more dominant adult health needs, and strong advocating for children will be needed within this reform or there will be missed opportunities for us all.” She adds there will be a need to advocate strongly for Otago and Southland to ensure they are not overlooked by decision-makers in Wellington. In Central Otago, Dunstan Hospital Rural Hospital specialist Garry Nixon sees potential for improvements in rural health from the national scale offered by Health NZ. “Rural health is a pretty small part of 20 different DHBs. The difficulty in rural is you need fundamentally different models of health care delivery.” He hopes a centralised function overseeing rural health will lead to increased networking and improvements in best practice. ASMS is keen to hear from other members about their views on the reforms and how they need to take shape. Please contact Senior Communications Advisor Eileen Goodwin – eileen.goodwin@asms.org.nz
