Govt announces a single national health board

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#2696633 22-Apr-2021 12:52

invisibleman18: Haven't read much of the detail so sorry if this is dumb, but what actual difference to healthcare will be made beyond all the money that will need to be spent on changing signage, uniforms and stationery? For the guy in the news who couldn't access specialty cancer care in Southland, what difference does this make if there is still no specialty facility in the region?

There's no detail published, but hopefully it means a single national system for patient information. So if a Gore person has an accident in Kaitaia, their health information will be as accessible as if they were in Southland. And, when they get back to Gore, the details of their accident and treatment will be available to Southland doctors.

It may mean a redistribution of specialists up and down the country, so that there is more equal access to services. But I wouldn't hold my breath on that. I suspect more likely there will be a reduction in the number of locations that uncommon specialties are available, because that will save some money. So more people will have to travel to Auckland than at present. In the long term, it will mean more hospital consolidation (because there's no local control), so small hospitals closing, and shrinking of some medium-sized ones (e.g. Whanganui) where they're close to another large one.

Probably there will be some money saved by having only one set of software licenses instead of 20, although no doubt the price of each single large license will be close to the price of 20 small ones. Probably there will be a bit of money saved by having one high-powered board and management instead of 20 small ones, but I expect the high-powered people will get paid more, and there will be more layers on the pyramid. Probably there will be some money saved by having one large set of IT, HR, and other support services instead of 20 small ones, but probably not much... there will be more layers on the pyramid, and there will still be a need to have support people on-site at each hospital. And maybe the money saved will be used to improve services, but more likely it will shrink the Health budget.

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#2696645 22-Apr-2021 13:18

frankv:

In the long term, it will mean more hospital consolidation (because there's no local control), so small hospitals closing

Isn't this analogous to todays comment that back office will reduce but front line wont as we are short of them? DHB's are the head offices/admin function so to speak, would that not go to HO being in Wellington , front line admin being at hospitals/centres, and overall, front line health care/centres can be expanded overall?

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#2696684 22-Apr-2021 13:52

tdgeek:

frankv:

In the long term, it will mean more hospital consolidation (because there's no local control), so small hospitals closing

Isn't this analogous to todays comment that back office will reduce but front line wont as we are short of them? DHB's are the head offices/admin function so to speak, would that not go to HO being in Wellington , front line admin being at hospitals/centres, and overall, front line health care/centres can be expanded overall?

I'm not sure what you mean by today's comment... presumably a press release or interview or something, which I haven't seen.

What you say sounds good. But in reality there's a shortage of back office people too, because they've been pared to (below) the minimum practical by 30 years of underfunding. And someone has to build (and pay for) the new system.

And, at some point in the future, decisions will need to be made between expanded front line health care/centres, funding for Maori health, more specialists at regional hospitals, a new CT scanner in Auckland, and a new frigate for the Navy. At which point you'll see the value of politicians' promises.

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#2696729 22-Apr-2021 15:38

sbiddle:
I've only spent probably 30 mins reading up on this last night but to me what the Govt is planning shares many similarities with what the intended outcome was of the CHE model - while the individual boards are going, the focus is also going to be on primary healthcare and focused regional resources which was a key part of the CHE model.

Biggest problem we've had is close to 40 years of health under funding by every Government. If that doesn't change, a restructure isn't going to fix anything.

The CHE model was based on the ideology of the day - if you have a "market" "competition" will fix all inefficiencies and delivery problems and we can all walk into consumer nirvana. It was pretty clearly an intermediate step to unwinding public health and bringing in private health.

It never functioned as a competitive market and was largely a duplication of bureaucracy.

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#2696760 22-Apr-2021 17:26

frankv:

It may mean a redistribution of specialists up and down the country, so that there is more equal access to services. But I wouldn't hold my breath on that. I suspect more likely there will be a reduction in the number of locations that uncommon specialties are available, because that will save some money. So more people will have to travel to Auckland than at present. In the long term, it will mean more hospital consolidation (because there's no local control), so small hospitals closing, and shrinking of some medium-sized ones (e.g. Whanganui) where they're close to another large one.

I think you are miles off. One of the biggest issues that is being addressed is access to services. Would you rather have access to high-quality specialist services with travel, or low-quality services down the road? We have 5m population and the key here is ready diagnosis within a reasonable distance and high-quality specialty services in 5-6 locations. This approach will lead to increased hospital locations for most services, and streamlined processes for treatment.

frankv:

Probably there will be some money saved by having only one set of software licenses instead of 20, although no doubt the price of each single large license will be close to the price of 20 small ones. Probably there will be a bit of money saved by having one high-powered board and management instead of 20 small ones, but I expect the high-powered people will get paid more, and there will be more layers on the pyramid. Probably there will be some money saved by having one large set of IT, HR, and other support services instead of 20 small ones, but probably not much... there will be more layers on the pyramid, and there will still be a need to have support people on-site at each hospital. And maybe the money saved will be used to improve services, but more likely it will shrink the Health budget.

I think you are miles off here also. The reforms are to do with integrated planning, integrated delivery of services to all, and improved services for the money. There is no need to do this stuff 20 different ways in 20 different locations - the model that has led to the problem we have. There will be some savings in IT costs (IT spending in health is appallingly badly managed due to gross incompetence throughout the sector) and bureaucracy; but these are small components of the overall spend and therefore not significant.

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#2696785 22-Apr-2021 18:37

BlinkyBill:

I think you are miles off here also. The reforms are to do with integrated planning, integrated delivery of services to all, and improved services for the money. There is no need to do this stuff 20 different ways in 20 different locations - the model that has led to the problem we have. There will be some savings in IT costs (IT spending in health is appallingly badly managed due to gross incompetence throughout the sector) and bureaucracy; but these are small components of the overall spend and therefore not significant.

I think you are miles off. @frankv has skin in the game, or does, or did. Who cares about IT savings? What we need to care about is:

1. IT where everyone (GP doctors, patients, private and public hospitals, health centres have access to the same data, its not 13 legacy systems (my exaggeration)

2. Cost savings by reducing duplication

3. More focus on direct frontline health, which is short staffed and admitted.

You cannot have everywhere, providing every possible healthcare solution. There is no burn centre in 20 locations, I believe it is 3 at the moment.

Centralise the CEO etc functions, and obviously the regional functions will stay as they are, hopefully spread better and more efficiently. Do you want 20 companies providing widgets, or do you want one company providing widgets to 20 centres?

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#2696788 22-Apr-2021 18:51

In the short term this announcement is likely to just add an extra layer of bureaucracy over the top of the DHB's, and it is going to be a complex exercise to consolidate functions, so initially it will just add staff but won't result in a lot of cost savings.

it will change the governance of the DHB's and get rid of the elected boards, which I agree with as I don't believe that this gave the public much say anyway.

It is disappointing that this proposal wasn't announced prior to the election, it is a significant change that was almost certainly planned prior, so they should have exposed it to the scrutiny of the voters. I also don't think this is the right time to be making major changes when we are in the middle of a pandemic.

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#2696789 22-Apr-2021 19:02

tdgeek:

BlinkyBill:

I think you are miles off here also. The reforms are to do with integrated planning, integrated delivery of services to all, and improved services for the money. There is no need to do this stuff 20 different ways in 20 different locations - the model that has led to the problem we have. There will be some savings in IT costs (IT spending in health is appallingly badly managed due to gross incompetence throughout the sector) and bureaucracy; but these are small components of the overall spend and therefore not significant.

I think you are miles off. @frankv has skin in the game, or does, or did. Who cares about IT savings? What we need to care about is:

1. IT where everyone (GP doctors, patients, private and public hospitals, health centres have access to the same data, its not 13 legacy systems (my exaggeration)

2. Cost savings by reducing duplication

3. More focus on direct frontline health, which is short staffed and admitted.

You cannot have everywhere, providing every possible healthcare solution. There is no burn centre in 20 locations, I believe it is 3 at the moment.

Centralise the CEO etc functions, and obviously the regional functions will stay as they are, hopefully spread better and more efficiently. Do you want 20 companies providing widgets, or do you want one company providing widgets to 20 centres?

Well, I think we have the same view, actually. That’s what my post actually says. For context, my company does a couple of $million annually in health sector IT at the Ministry and four of the large DHB’s for the past 20-25 years, so I have some idea here. I’m expecting to increase that by 3x due to the work upcoming.

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#2696906 23-Apr-2021 06:43

BlinkyBill:

Well, I think we have the same view, actually. That’s what my post actually says. For context, my company does a couple of $million annually in health sector IT at the Ministry and four of the large DHB’s for the past 20-25 years, so I have some idea here. I’m expecting to increase that by 3x due to the work upcoming.

Im sure it will. Shared systems, ease of data gathering and sharing, making it far more efficient to deal with patients needs, so the CEO etc, offsite can manage the overall health function and the onsite healthcare workers and local smaller admin can get it done. I guess there will be complaints that I had to travel here to get care, but you can't have all care everywhere. Our health system has to cater for a population half that of Los Angeles, but our population is spread out from Kaitaia to Bluff

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#2696908 23-Apr-2021 06:49

nova:

I also don't think this is the right time to be making major changes when we are in the middle of a pandemic.

Its precisely the right time. How many Covids are in wards at the moment? None. A pandemic will happen again, probably sooner than later, and in NZ we aren't free of it given the outside world, its the best time to make healthcare more efficient. Over the course of this restructure which is more an admin and management restructure, your visit to a hospital won't look any different. One would hope the care timeline will get better

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#2696920 23-Apr-2021 08:07

frankv:

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.

the current thinking in cancer care is about removing obstacles and distance to services, making the outcomes across the population more equitable regardless of ethnicity/location etc. Using the RCTS as the example, taranaki and HAwkes bay people travel to PN for radiation treatment at present. Both Hawkes bay and taranaki will have their own smaller units in the next few years, operated and managed under the umbrella of the RCTS. The likely result from this scenario is there will be the very high chance that other regions (northland etc) further from a main cancer centre may have something similar happen there as well.

this shows despite the current news of a the chance to the health service that their is and still will be “regional thinking” in regards to the delivering of healthcare, to improve outcomes services will need to be “taken” to the people in order to reduce obstacles in the treatment path.

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#2696923 23-Apr-2021 08:17

Loismustdye:

the current thinking in cancer care is about removing obstacles and distance to services, making the outcomes across the population more equitable regardless of ethnicity/location etc. Using the RCTS as the example, taranaki and HAwkes bay people travel to PN for radiation treatment at present. Both Hawkes bay and taranaki will have their own smaller units in the next few years, operated and managed under the umbrella of the RCTS. The likely result from this scenario is there will be the very high chance that other regions (northland etc) further from a main cancer centre may have something similar happen there as well.

this shows despite the current news of a the chance to the health service that their is and still will be “regional thinking” in regards to the delivering of healthcare, to improve outcomes services will need to be “taken” to the people in order to reduce obstacles in the treatment path.

The difference is that instead of 20 DHB's deciding, trying to agree, trying to budget, where to treat cancer, one Head office will do that. If the best outcome is a cancer care centre in every region, one Head office can arrange that better. If I owned a business with 20 branches, that's easier to manage than if I was the CEO and these 20 branches were owner operated. One manager, not 20. One NZ budget, not 20

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#2696937 23-Apr-2021 09:06

BlinkyBill:

I think you are miles off. One of the biggest issues that is being addressed is access to services. Would you rather have access to high-quality specialist services with travel, or low-quality services down the road? We have 5m population and the key here is ready diagnosis within a reasonable distance and high-quality specialty services in 5-6 locations. This approach will lead to increased hospital locations for most services, and streamlined processes for treatment.

For myself, I'd prefer high quality services, even if it involves travel. But I'm in the happy position of being able to travel.

But I don't believe that we will see improved services at more locations. Instead, I expect that we will see about the same level of services, perhaps delivered at less cost. Because cost is *always* a criterion.

I think you are miles off here also. The reforms are to do with integrated planning, integrated delivery of services to all, and improved services for the money. There is no need to do this stuff 20 different ways in 20 different locations - the model that has led to the problem we have. There will be some savings in IT costs (IT spending in health is appallingly badly managed due to gross incompetence throughout the sector) and bureaucracy; but these are small components of the overall spend and therefore not significant.

I admire your optimism. But the existing appalling management hasn't been able to deliver, and I expect that the management of the new national DHB will be sourced mostly from the existing management, at best the best of a bad lot. So I don't expect as much progress as you or the Minister. And I fully expect that the bureaucracy will swell rather than be removed. I hope I'm wrong.

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#2696950 23-Apr-2021 09:09

tdgeek:

@frankv has skin in the game, or does, or did.

Just to be clear... I worked in Health IT for about a decade, at 2 different DHBs. I left Health IT about a year ago.

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#2697293 23-Apr-2021 17:38

frankv:

BlinkyBill:

I think you are miles off here also. The reforms are to do with integrated planning, integrated delivery of services to all, and improved services for the money. There is no need to do this stuff 20 different ways in 20 different locations - the model that has led to the problem we have. There will be some savings in IT costs (IT spending in health is appallingly badly managed due to gross incompetence throughout the sector) and bureaucracy; but these are small components of the overall spend and therefore not significant.

I admire your optimism. But the existing appalling management hasn't been able to deliver, and I expect that the management of the new national DHB will be sourced mostly from the existing management, at best the best of a bad lot. So I don't expect as much progress as you or the Minister. And I fully expect that the bureaucracy will swell rather than be removed. I hope I'm wrong.

I think you missed the point I’m trying to make. I think there will be little cost savings, relative to the whole spend, from software/it costs. Relative to the spend, there will be little cost-saving from rationalisation of management and managers.

My point is the objective of the reforms is to improve services, not save costs. And the improvement will come from singular design and common operating principles.

When there is one design team with nationwide objectives, that will bring better outcomes than 20 service delivery designs in 20 districts. To me that makes sense.

In-region management will still be there, but they will all operate in the same way, directed from the core.

That’s what I think the Govt is trying to achieve. I doubt they will be awesomely successful, but it will be better than the current situation.

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