Political responsibility

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Brendan

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#2006336 2-May-2018 00:59

MikeB4:

I read often that our health service is badly broken, however I struggle with this. As many here know I suffer from a long term chronic illness, last week a flare up started and by Friday morning it reached a level that I needed to act. I rang the clinic at our hospital and spoke at length to my nurse specialist. She said she will go and talk with my specialists and come back to me. Two hours later she rang me back with a list of things I can do, she also advised that the specialist has send an email to my GP giving him advice as to what should be done if the situation deteriorates. The nurse also advised that she will arrange an urgent appointment for me at the hospital.

That evening my GP rang to see how I am going and advised he has faxed a script to my pharmacy. This Monday I received a letter from the hospital with details of my appointment which is Monday next week. My GP rang me again this morning.

So, to me I feel our health service is doing OK, sure it's not perfect but on the limited resources available they do a good job and the staff are dedicated individuals.

You live in a well funded DHB I would guess.

I have several life threatening illnesses, and so have some familiarity with the health system myself. And while I have been shown priority treatment numerous times, I have also had to deal with long delays, transfers to other DHB's due to funding shortages, long trips, etc, etc.

The staff themselves have generally been excellent but facilities fall far short. Staffing levels fall far short. Stupid decisions from management affecting thousands. The list goes on.

No mike, it is broken. If you have the bad luck to be in a DHB with a large geographical footprint and lower population, you will know.

When the DHB next door - which happens to be closer to you than your assigned one! - cannot be used because of an imaginary line on a map, then You Will Know the health system is broken.

And it is deliberately broken. It has been MADE broken over several decades. It is planned brokenness.

MikeAqua

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#2006511 2-May-2018 12:25

MikeB4:

I read often that our health service is badly broken, however I struggle with this. As many here know I suffer from a long term chronic illness, last week a flare up started and by Friday morning it reached a level that I needed to act. I rang the clinic at our hospital and spoke at length to my nurse specialist. She said she will go and talk with my specialists and come back to me. Two hours later she rang me back with a list of things I can do, she also advised that the specialist has send an email to my GP giving him advice as to what should be done if the situation deteriorates. The nurse also advised that she will arrange an urgent appointment for me at the hospital.

That evening my GP rang to see how I am going and advised he has faxed a script to my pharmacy. This Monday I received a letter from the hospital with details of my appointment which is Monday next week. My GP rang me again this morning.

So, to me I feel our health service is doing OK, sure it's not perfect but on the limited resources available they do a good job and the staff are dedicated individuals.

+1. I have been significant user of the public health system in the last year or two. I have to say I have been pleasantly surprised. I was expecting a total nightmare.

There have been some maddening administrative inefficiencies, but the actual medical services have been timely and professional.

Mike

networkn

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#2006525 2-May-2018 12:59

Brendan:

You prove my point.

And you mine.

This is a microcosm of where you go wrong Andre. You are adversarial and - typical with many "righties" in my experience - cannot conceive that other people may in fact work differently. I even wonder if you are aware of it yourself.

We are not in debate.

What you are finding confusing is that I am agreeing with you, but you do not understand what I am saying.

I *can* be adversarial (though I try reallly hard to do some with a level of respect. I do not go out of my way to hurt others feelings), but I can also be a lot of other things. I have a relatively open mind, but I expect to have clear evidence to support a view that would cause me to change my position. I don't see a huge amount of that in political threads. There have been times in recent political discussions where I have changed my mind on an issue. I don't expect people to do something I wouldn't be prepared to do myself. When I state an opinion I will almost always cite something that shows why my position is such (Unless it's pretty glaringly obvious). I will accept that I see a fair bit of stuff in 2 shades. For me an apple is an apple in most cases. A liar is a liar.

I *do* love being lectured and/or patronised by people who display similar traits as they accuse me of though. /s

Your claim we agree, seems strange given you said " And they simply will not do it while the People sit in forums like this arguing pot calls kettle black." Unless there was sarcasm here I did not detect, perhaps you could explain how I misunderstood this as an agreement to my comment that politicians are not impeded in any way from doing their jobs as a result of what has been said in this thread/Forum? It's possible I am having a comprehension failure, I am happy for you to demonstrate it.

Then we have the bulk of the iceberg beneath the water. It is slow and bulky and dark with lots of holes in it. Labyrinthine. Full of little fiefdoms, provinces and management fair tales and all too comfortable with the status quo.

There will be no rapid change in course because of this. Any radical improvement will take a major culture shift in the public service.

How that will be achieved will be difficult, but it'll HAVE to happen. Our traditional presumptions are fast becoming untenable and the cracks are becoming chasms. The system will either catastrophically correct itself or we will design a better one. The status quo cannot last much longer.

One bright light has been the dawning realization that neo-liberalism is a bad idea.

I await the inevitable ridiculous presumptions and accusations.

This isn't healthcare specific, this is large organization specific everywhere. The more people involved the less efficient something is unless companies are rigid in following SOP's which reduces their flexibility which is a whole other thing. I agree changes need to be made. I believe that unfortunately, the changes that need to be made are so huge that it would be political suicide to do it. The person making those decisions will be derided, but eventually remembered as somewhat of a visionary. Thing is, no matter where in the world you look, there are people complaining about health care systems, even in countries who apparently have it better than us. It's not an excuse not to try, but perhaps we need peoples expectations to be set more appropriately.

You were doing so well with that last paragraph until your last line. You complain about my posting style, but why is your comment any less tone lowering than any other?

MikeAqua

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#2006541 2-May-2018 13:35

networkn:

This isn't healthcare specific, this is large organization specific everywhere. The more people involved the less efficient something is unless companies are rigid in following SOP's which reduces their flexibility which is a whole other thing.

DHBs do seem to engage in a special kind of admin inefficiency.

For example I once received an appointment letter sent to me in Nelson for an appointment in Auckland. By the time I received this letter it was 3 days before the appointment. Flights that day were sold out. A follow up phone call eventually revealed the location was wrong anyway (Greenlane instead of Grafton).

A corrected letter was emailed to me for a much later date. Problem solved I thought. Then I received a letter castigating me for not attending the appointment in the original letter and no further appointments would be available till me until I contacted the DHB call centre. So I did and it turned out the original appointment was never cancelled so I was a no-show.

Initially there was failure to consider that a person in Nelson might need more than 3 days notice to attend an appointment in Auckland. Then the information was incorrect, resulting in a whole lot more admin time being used. Finally because the original appointment was never cancelled a time was wasted that someone else could have used.

A bit of an admin nightmare in which 100% of verbal and 66% of written correspondence was just fixing stuff ups.

Mike

networkn

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#2006543 2-May-2018 13:39

MikeAqua:

networkn:

This isn't healthcare specific, this is large organization specific everywhere. The more people involved the less efficient something is unless companies are rigid in following SOP's which reduces their flexibility which is a whole other thing.

DHBs do seem to engage in a special kind of admin inefficiency.

For example I once received an appointment letter sent to me in Nelson for an appointment in Auckland. By the time I received this letter it was 3 days before the appointment. Flights that day were sold out. A follow up phone call eventually revealed the location was wrong anyway (Greenlane instead of Grafton).

A corrected letter was emailed to me for a much later date. Problem solved I thought. Then I received a letter castigating me for not attending the appointment in the original letter and no further appointments would be available till me until I contacted the DHB call centre. So I did and it turned out the original appointment was never cancelled so I was a no-show.

Initially there was failure to consider that a person in Nelson might need more than 3 days notice to attend an appointment in Auckland. Then the information was incorrect, resulting in a whole lot more admin time being used. Finally because the original appointment was never cancelled a time was wasted that someone else could have used.

A bit of an admin nightmare in which 100% of verbal and 66% of written correspondence was just fixing stuff ups.

I am sure you could find similar in the education segment, though obviously different.

I am not saying there ISN'T a problem, and that we can't expect and DO better, but I do think peoples expectations should be tempered.

MikeAqua

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#2006568 2-May-2018 14:36

networkn:

I am sure you could find similar in the education segment, though obviously different.

I am not saying there ISN'T a problem, and that we can't expect and DO better, but I do think peoples expectations should be tempered.

Good point. Universities can be similar.

The thing is: Doing something properly the first time saves a whole lot of stuff-up recovery effort later. This suggests to me that up-front accuracy is worth investing in.

Mike

networkn

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#2006594 2-May-2018 15:21

MikeAqua:

networkn:

I am sure you could find similar in the education segment, though obviously different.

I am not saying there ISN'T a problem, and that we can't expect and DO better, but I do think peoples expectations should be tempered.

Good point. Universities can be similar.

The thing is: Doing something properly the first time saves a whole lot of stuff-up recovery effort later. This suggests to me that up-front accuracy is worth investing in.

Sure. As someone with a small business, and as someone who advises small businesses, one of the first things we talk about, is how much easier processes are to install earlier than after you have 10+ people. I wouldn't' say we are perfect at it as it stands, but we are trying hard.

Reality is, healthcare systems have been around a long time, the healthcare landscape is very different from even 10 years ago as to what technology exists, what laws around things like data protection etc etc etc, and even stuff of a non-technical nature. Processes only work until the stuff they rely upon changes. Best practices from 20 years ago wouldn't bear much resemblance to now except in some simple and fundamental ways. It's not an easy thing to keep an organization with as many conflicting priorities as health care efficient.

No matter how idealistic you are, even taking stock of what you have in an ecosystem the size of healthcare is virtually impossible because, by the time you are finished, it's out of date. At the same time as auditing what you have, you have the complication of the priorities of the thousands of people who work there. Some of those will directly conflict. Workarounds for those are one of the main reasons healthcare is inefficient. Sometimes workarounds are installed, because something that will change something, isn't being installed till later but department 1 has a pressing need for urgent changes.

Again these aren't arguments for not doing something, just tempering expectations. It's easy to look from the outside, and say "hey if only you had done this, instead of that, this whole situation wouldn't have occurred.

If David Clarke had "only just" read the red folder he was given, this thread wouldn't exist, and poor David would not be availing himself of the surgical department of the healthcare system he is responsible for to remove his foot from his mouth! :) (oh no, am I being adversarial again? :) )

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Brendan

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#2007558 4-May-2018 02:37

networkn:

Brendan:

This is a microcosm of where you go wrong Andre. You are adversarial and - typical with many "righties" in my experience - cannot conceive that other people may in fact work differently. I even wonder if you are aware of it yourself.

We are not in debate.

What you are finding confusing is that I am agreeing with you, but you do not understand what I am saying.

I *can* be adversarial (though I try reallly hard to do some with a level of respect. I do not go out of my way to hurt others feelings), but I can also be a lot of other things. I have a relatively open mind, but I expect to have clear evidence to support a view that would cause me to change my position. I don't see a huge amount of that in political threads. There have been times in recent political discussions where I have changed my mind on an issue. I don't expect people to do something I wouldn't be prepared to do myself. When I state an opinion I will almost always cite something that shows why my position is such (Unless it's pretty glaringly obvious). I will accept that I see a fair bit of stuff in 2 shades. For me an apple is an apple in most cases. A liar is a liar.

Such a simplistic view will inevitably result in a lot of mistakes.

I *do* love being lectured and/or patronised by people who display similar traits as they accuse me of though. /s

Your claim we agree, seems strange given you said " And they simply will not do it while the People sit in forums like this arguing pot calls kettle black." Unless there was sarcasm here I did not detect, perhaps you could explain how I misunderstood this as an agreement to my comment that politicians are not impeded in any way from doing their jobs as a result of what has been said in this thread/Forum? It's possible I am having a comprehension failure, I am happy for you to demonstrate it.

You are having a comprehension failure. Maybe I should have explained it clearly, but I did not.

Politicians try to appear to be representing their supporters feelings and opinions. As we have different factions in society, we have different political representation.

Without a clear mandate, Politicians will maintain the status quo or shift blame. People arguing in forums is simply a microcosm of wider society these days. An imperfect one. The misunderstanding was in assuming a simple linear CAUSE -> EFFECT was my intended meaning, rather than considering FEEDBACK or interdependent complexity.

In other words, Politicians are society and society is politicians. What we need is intelligent leadership and educated population. But that has been deliberately eroded for generations through defunding.

Then we have the bulk of the iceberg beneath the water. It is slow and bulky and dark with lots of holes in it. Labyrinthine. Full of little fiefdoms, provinces and management fair tales and all too comfortable with the status quo.

There will be no rapid change in course because of this. Any radical improvement will take a major culture shift in the public service.

How that will be achieved will be difficult, but it'll HAVE to happen. Our traditional presumptions are fast becoming untenable and the cracks are becoming chasms. The system will either catastrophically correct itself or we will design a better one. The status quo cannot last much longer.

One bright light has been the dawning realization that neo-liberalism is a bad idea.

I await the inevitable ridiculous presumptions and accusations.

This isn't healthcare specific, this is large organization specific everywhere.

That's right.

The more people involved the less efficient something is unless companies are rigid in following SOP's which reduces their flexibility which is a whole other thing.

It's the Dinosaur model of management theory - huge body, tiny brain - the average intelligence density goes down the larger the beast becomes. At a certain point they are only capable of basic animal level planning. This is why small, new companies are the innovators.

It has all sorts to do with information theory and game theory.

I agree changes need to be made. I believe that unfortunately, the changes that need to be made are so huge that it would be political suicide to do it. The person making those decisions will be derided, but eventually remembered as somewhat of a visionary. Thing is, no matter where in the world you look, there are people complaining about health care systems, even in countries who apparently have it better than us. It's not an excuse not to try, but perhaps we need peoples expectations to be set more appropriately.

I disagree. When you have 60% of the worlds wealth in the hands of 1% of it's population, you have an extreme example of the Dinosaur problem.

It also ignores history. The NHS was formed in the UK in a time of economic depression, mass unemployment and destroyed infrastructure and social chaos. You could not have chosen a worse time economically. Yet it became an example to world and one NZ emulated.

Sickening that in a time of plenty such as the world has never known, we now cry poverty and can't do.

It's not the lack of materials or knowledge.

You were doing so well with that last paragraph until your last line. You complain about my posting style, but why is your comment any less tone lowering than any other?

I was predicting this:

I *do* love being lectured and/or patronised by people who display similar traits as they accuse me of though. /s

One of the main reasons I do not often participate is because I spend all my time explaining what I previously said, then arguing over minutiae, then being accused of being a shill for this or that, and then finally someone will decide I'm a Nazi or a communist (or both at the same time) if I have not quit already.

As I said: who has the energy for it? I don't. So I hope I have clarified my thoughts on the subject enough and given you something to ponder.

networkn

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#2007698 4-May-2018 10:28

Brendan:

You are having a comprehension failure. Maybe I should have explained it clearly, but I did not.

Actually, It doesn't appear I was having a comprehension failure, the failure appears to be more a case of you failing to communicate clearly.

Politicians try to appear to be representing their supporters feelings and opinions. As we have different factions in society, we have different political representation.

Without a clear mandate, Politicians will maintain the status quo or shift blame. People arguing in forums is simply a microcosm of wider society these days. An imperfect one. The misunderstanding was in assuming a simple linear CAUSE -> EFFECT was my intended meaning, rather than considering FEEDBACK or interdependent complexity.

In other words, Politicians are society and society is politicians. What we need is intelligent leadership and educated population. But that has been deliberately eroded for generations through defunding.

I think the NZ public was pretty clear on what it wanted by electing who we did. The problem is that the current Government overestimated it's abilities and I believe, miscalculated the costs as a direct result of that, and a general lack of planning. NZ wants a more social spend from it's tax dollars, which is a fair enough swing, given the prior 9 years of focus on financial restoration. Both parties were going to spend more on social this term, but I think a fair percentage of the population simply got "bored" with seeing the same old faces and voted for change. I don't think Labour is going to do a better job in social spending this term or next if God forbid they get another term. I thought initially that they might, even "hoped" for it, but the reality is something entirely different and disappointing to say the least.

Every 3 years, parties are judged on what they have achieved. If NZ is satisfied then the incumbent gets a second term, if not, someone new gets in.

I disagree. When you have 60% of the worlds wealth in the hands of 1% of it's population, you have an extreme example of the Dinosaur problem.

It also ignores history. The NHS was formed in the UK in a time of economic depression, mass unemployment and destroyed infrastructure and social chaos. You could not have chosen a worse time economically. Yet it became an example to world and one NZ emulated.

I see this differently. Back then I see that very few countries had the resources or internal knowledge to create their own comprehensive systems. Whilst the NHS was not amazing, it was simply better than the systems they could have created themselves. I believe most countries intended to then change it to suit their own requirements.

Sickening that in a time of plenty such as the world has never known, we now cry poverty and can't do.

I don't see money as the primary reason things aren't changing, at least in NZ. Do you really think it is? The wealth you speak about being held by 1% is being held by private corporations and people, are you proposing they should spend their money to fix healthcare?

I was predicting this:

But didn't answer the question anyway? Why is it, I am not allowed to be "adversarial", but you are ok to post passively aggressively, or make negative jibes?

One of the main reasons I do not often participate is because I spend all my time explaining what I previously said, then arguing over minutiae, then being accused of being a shill for this or that, and then finally someone will decide I'm a Nazi or a communist (or both at the same time) if I have not quit already.

As I said: who has the energy for it? I don't. So I hope I have clarified my thoughts on the subject enough and given you something to ponder.

You make an interesting point, but I find it ironic you can't see it. Have you considered that the reason you end up in the same position in so many discussions as you have said, is down to your communication style? I found your comments on the NHS very confusing. I am still not entirely sure the point you were trying to make. I was interested, I just can't quite see the conclusion.

You should expect that if you feel ok to challenge other peoples opinions and behaviour, the same should be fair game in your own.

It feels a little like you can hand it out, but can't take it. I am not saying that in a nasty way.

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