Govt announces a single national health board

Forums › Health and fitness › Govt announces a single national health board

1 | 2 | 3 | 4 | 5 | 6 | 7 | 8

6734 posts

Uber Geek
+1 received by user: 2927

Subscriber

#2696125 21-Apr-2021 15:10

PolicyGuy:
I expect there will be a devolved regional structure if only because having all the bureaucrats in one place in Wellington or Auckland would be far too expensive.
I'd look for maybe five "Regional Health Service Delivery Offices": 'Northern Region' for everything north of the Bombay Hills ; 'North Central Region' (or maybe 'Aotea', anything but 'Waikato') for Taupo to the Bombay Hills; 'Central Region' for Taupo to Levin, 'Remutaka Region' (not 'Wellington' or 'Capital') for Wellington, Wairarapa and Kapiti; and "Southern Region" for the whole South Island.

If they were smart, the Regional offices would not go where the existing DHB head offices are, both for optics and for regional development: maybe something like Northern in Albany, North Central in Rotorua or Cambridge, Central in Marton or Dannevirke, Remutaka in Porirua, Southern in Timaru or Blenheim.

Just my $0.02
:)

Why create artificial regions that wouldn't be self sufficient? If I was in Levin I might go north to Taupo for a holiday, I'd be heading south for medical care.

antonknee

1133 posts

Uber Geek
+1 received by user: 1145

#2696127 21-Apr-2021 15:11

frankv:

To be fair, when Taupo's hospital was set up, it was probably a pretty rough 3-hour-plus trip to Rotorua, and an overnighter to Auckland. It's not unreasonable for health services to take advantage of improvements in transport.

I guess the question you need to answer is how much extra you (and every other taxpayer) would be prepared to pay each year to ensure that all the grandfathers around the country could be treated in their home towns? Even if you settled for within an hour's drive of home, I think it would be an astronomical amount.

And it might not even be possible. For example, the problem Whanganui DHB ran into with obstetrics was that, to provide a 24/7 service, they needed 3 obstetricians, to allow for leave and training and so on. But, to maintain their registration, specialists have to do a certain number of their specialist operations each year. And there weren't that many needed in the WDHB district. So their obstetrics service is AFAIK provided by one obstetrician, and sometimes patients have to go to PN hospital.

So, to provide the service that your grandfather needed, the hospital would need to have 3 specialists. And probably a couple of million dollars worth of machines and infrastructure. And so would all the other small hospitals. But there wouldn't be enough operations in the area for all those specialists to maintain their registration. Should we lower our standards so that it's possible to staff those small hospitals? Rotate the staff between the big & small hospitals? Have those expensive specialists commute to and fro?

It was a reply to a specific concern raised by another poster that this move would result in people having to travel for care - my point was that this is already something that happens regardless. I actually think there is a chance that a national agency would approach this better and allow for less travel based on being able to provision services nationally where the need is rather than individual DHBs considering just their region.

I don't think it's feasible to have every single health service point provide every service for precisely the reasons you point out, and the reality will always be people in smaller centres can't access everything locally. Same issue as rural broadband and a myriad of other things. Though I do think a national approach will see this work better than the current DHB by DHB siloed approach and probably be more effective and efficient.

tdgeek

30048 posts

Uber Geek
+1 received by user: 9455

Trusted

Lifetime subscriber

#2696129 21-Apr-2021 15:12

Geektastic:

I turned up at Masterton hospital for surgery, scrubbed and ready. Only be told they weren’t operating that day due to staff shortages.

Same happened to me, but they did me late. But whats that got to do with the restructure? Staff shortages happen. Sick, late leave, etc. You got booked in at a time that suited, later it didnt suit

tdgeek

30048 posts

Uber Geek
+1 received by user: 9455

Trusted

Lifetime subscriber

#2696135 21-Apr-2021 15:19

frankv:

Finally, research shows that spending on hospital IT has a tenfold return in efficiency improvements for the clinical staff. Less missed operations, less missed appointments, better treatment, shorter stays, etc. Better IT improves pretty much every hospital efficiency metric. This is finally percolating up to senior management.

This was evident in the earlier Covid days. Different areas had different systems. Aside from cost savings, if every health care worker in NZ had access to the same systems our one public healthcare provider uses, it surely must remove a lot of obstacles and time wasting

mattwnz

20520 posts

Uber Geek
+1 received by user: 4797

#2696137 21-Apr-2021 15:22

I wonder if they are going to be doing the same with councils for some services, which some councils struggle with. It is a mess. eg Building consents. Planning... releasing land for housing etc

antonknee

1133 posts

Uber Geek
+1 received by user: 1145

#2696143 21-Apr-2021 15:38

mattwnz:

I wonder if they are going to be doing the same with councils for some services, which some councils struggle with. It is a mess. eg Building consents. Planning... releasing land for housing etc

I hope so - your average council is pretty incompetent, and there could be some good efficiencies and savings to be had. I think we are starting to see more centralisation, just look at the current water proposals.

I realise it's an unpopular opinion but local governance is mostly ineffective IMO, particularly where it has to interface with regional or central government, and particularly on issues of national importance (cough housing). Talk about wanting local representation and taking away people's voices as much you want, but the reality is most people don't engage in local government anyway and mostly just pick someone without understanding who they are or their policies - in spite of it impacting their day to day more than central government.

AliExpress

Shop now on AliExpress (affiliate link).

frankv

5705 posts

Uber Geek
+1 received by user: 3666

Lifetime subscriber

#2696144 21-Apr-2021 15:39

1101:

how can we have centralized management without a centralized Computer (software) system , ie the same system nationwide .
Thats going to be another huge and and wastefull money pit .

Um... if centralised is a good idea (and I'm in favour of it for patient information), then spending money to make it happen (up to some limit) is also a good idea. It's not necessarily huge or wasteful.

There are a number of aspects though... hospitals have patient management systems (PMS) which are basically booking systems. Then they have clinical information systems (CIS), which contain patient clinical information -- lab results, operation summaries, outpatient letters, etc. Also the patient's interactions with the DHB, copied from the PMS. Then they have some kind of image archive, because some images can be huge. It would be entirely feasible to have a national CIS and separate PMSs.

There are distributed database systems that would function well for a CIS. And in many ways, that makes sense... most of a person's interactions with the Health system will be at a few locations, so their data could be located at the last hospital they visited, for example, or at a hospital near where they live. That would result in less data traffic (although that's not a huge issue), and probably better resilience to network failure. When you have an earthquake big enough to wipe out some of your fibre and some of the telco's switching systems, you really do want your hospital to continue to function.

But I predict a "Cloud" solution, hosted at MS's new datacenter, and backed up by their Sydney datacenter.

frankv

5705 posts

Uber Geek
+1 received by user: 3666

Lifetime subscriber

#2696145 21-Apr-2021 15:42

wellygary:

The problem is that there is an historically adverse relationship between the Ministry of Health (Govt) and GPs ( Private businesses) which results in lots of bureaucracy and overheads as the MoH work to make sure that GPs aren't lining their pockets too much..

That isn't restricted to GPs. The exact same relationship applies to MoH & DHBs.

sen8or

1897 posts

Uber Geek
+1 received by user: 1402

#2696148 21-Apr-2021 15:47

I just fear the rollout of a centralised IT system thats been scoped, costed and rolled out by anyone in central Government (labour or national or whomever, they are all pretty much equally useless), you just know its going to be a giant cluster F (and thats not even putting something arbitrary like a "reasonable timeframe" on it....)

frankv

5705 posts

Uber Geek
+1 received by user: 3666

Lifetime subscriber

#2696150 21-Apr-2021 15:52

tchart:

Call the local GP to talk to the nurse about getting antibiotics, but we have to talk to the GP.

Would be good to see some prescriptions able to be done by nurses to free up GP time.

There is a longstanding and deep divide between doctors and nurses. Generally speaking, doctors can diagnose and prescribe, nurses can't. This is also why a radiographer (the technician who operates the Xray machine) medico-legally cannot tell you that your bone is broken, even if the break is completely obvious. Some will take pity on the patient (and risk their jobs) and tell them what's obvious. You need a radiologist (a doctor who interprets Xrays) to diagnose what the problem is.

Some nurses (Clinical Nurse Specialists) can prescribe, but I think they work at hospitals, not GP practices.

PsychoSmiley

251 posts

Ultimate Geek
+1 received by user: 198

#2696155 21-Apr-2021 15:58

As somebody else in this game I'm going to be interested to know how they get everybody on the same page. Enacting change is a really struggle at times locally and god help you if you add one or two extra clicks to a process (clinical staff lose their minds due to the 'wasted' time). It is going to be cat herding on an epic scale and I welcome normalisation but I pity the people who have to make the decisions about this.

Geekzone support

Support Geekzone with one-off or recurring donations Donate via PressPatron.

frankv

5705 posts

Uber Geek
+1 received by user: 3666

Lifetime subscriber

#2696156 21-Apr-2021 16:00

Geektastic: Unless politicians are prepared to close hospitals when money runs out and only reopen them in the next FY, budgets are tantamount to pointless really. Think of them as guidelines, Minister....

Conversely, politicians will pare away the money year by year, and add new services to be provided, then blame the DHB for waiting list lengths and every other failure.

DHB management needs to have the balls to say "If you want to run the DHB on that, you'll have to find someone else, because I can't do it, and I don't believe it's possible". Instead, the games are played; creating projects that attract new Government funding, and deferring building a new hospital building until the Government stumps up a "one-off" payment for it, and all the rest.

tdgeek

30048 posts

Uber Geek
+1 received by user: 9455

Trusted

Lifetime subscriber

#2696160 21-Apr-2021 16:16

sen8or:

I just fear the rollout of a centralised IT system thats been scoped, costed and rolled out by anyone in central Government (labour or national or whomever, they are all pretty much equally useless), you just know its going to be a giant cluster F (and thats not even putting something arbitrary like a "reasonable timeframe" on it....)

MP's don't implement it, nor do employees, IT people do. IT people from the Health system or outside. MP's I assume say what thy want, based on what the health system says they need, after that, surely its in the hands of IT?

tdgeek

30048 posts

Uber Geek
+1 received by user: 9455

Trusted

Lifetime subscriber

#2696161 21-Apr-2021 16:18

frankv:

Geektastic: Unless politicians are prepared to close hospitals when money runs out and only reopen them in the next FY, budgets are tantamount to pointless really. Think of them as guidelines, Minister....

Conversely, politicians will pare away the money year by year, and add new services to be provided, then blame the DHB for waiting list lengths and every other failure.

DHB management needs to have the balls to say "If you want to run the DHB on that, you'll have to find someone else, because I can't do it, and I don't believe it's possible". Instead, the games are played; creating projects that attract new Government funding, and deferring building a new hospital building until the Government stumps up a "one-off" payment for it, and all the rest.

Like everything else in our tiny tiny country, which is spread out, making matters worse, it comes down to money, money from taxes.

frankv

5705 posts

Uber Geek
+1 received by user: 3666

Lifetime subscriber

#2696165 21-Apr-2021 16:20

antonknee:

I actually think there is a chance that a national agency would approach this better and allow for less travel based on being able to provision services nationally where the need is rather than individual DHBs considering just their region.

Yeah, it's possible. But there's already a fair amount of working together between various DHBs... WDHB/MDHB sharing of the obstetrics at WDHB is an example, and there's several more in this region. Another example is the Regional Cancer Treatment Service. But that results in people from Stratford (and I guess NP and Awakino?) driving to PN for treatment. So bigger is not necessarily better. But I guess under the national model NP north would go to Hamilton instead.

There is a very clear hierarchy of DHBs... big ones like CapCoast have the expensive but rare services, which all the DHBs in their region send patients to. Like the grandfather having to go to Auckland. Mid-sized ones like MidCentral do semi-regional stuff, supporting the small DHBs like Whanganui. And all the small hospitals that used to be shrink to aged care and/or maternity facilities and GP clinics.

But, for example, it's possible that instead of having 3 burns units (Middlemore, Hutt, Burnside), it might be perceived that just 2 would be better, and patients from the southern North Island having to go to Auckland or Christchurch. Any centralisation of patient treatment would inevitably result in more patient travel, not less.

1 | 2 | 3 | 4 | 5 | 6 | 7 | 8