Richard Prebble: Centralisation not the answer to fixing our hospitals


The heads of the nation’s District Health Boards (DHBs) had a meeting with the Minister of Health where they explained our hospitals are in crisis. If the nurses’ strike proceeded the hospitals would cease to function.

There are hospitals that are already at 120 per cent capacity, that is when patients are in the corridors. Emergency departments are overflowing with people waiting medically dangerous times. There are intensive care units that are full so operating theatres are being utilised for intensive care patients. Elective surgeries are being cancelled.

Nurses are working 12-hour shifts. It is unsustainable.

Hospitals have been served with PIN notices. To quote WorkSafe’s website:

“Provisional Improvement Notice (PIN) is a written notice issued by a Health and Safety Representative (HSR) to a person or a PCBU asking them to address a health and safety concern in the workplace”.

The hospital managers are legally required to resolve the safety issue or call in WorkSafe to inspect, who can issue cease work notices and possibly prosecute.

WorkSafe is making a very public audit of a private food company. What action, if any, will Worksafe take to address the very serious safety issues in our public hospitals?

The minister’s response was “fingers crossed”. Maybe he knew of the nurses’ new pay offer. With inflation in petrol, food and rent, it is going to have to be a compelling offer.

To be fair to the minister, some issues are not of his making. With the lockdowns, social distancing and hand washing our children did not acquire immunity against RSV.

Many of the problems are of the minister’s making. The Government’s plan to merge all the DHBs into one centralised health system is doing huge damage.

The DHBs are only allowed to engage senior appointments on short-term contracts to June 30 next year. People desperate enough to take an 11-month contract are not who we want running our hospitals.

Health professionals are in a global market. Australia and Canada are actively recruiting our health professionals with better pay, conditions and longer contracts.

Even if the DHBs could find overseas professionals willing to accept a short-term contract their families cannot get a visa to join them. We are losing our health professionals and cannot replace them.

The Auditor-General released his advice to DHBs. “It is not unusual for staff to consider their employment options during periods of uncertainty. Losing key staff, combined with any impact from the uncertainty about the reforms on your organisation, can diminish previously effective safeguards, reduce productivity, and increase the risk to safe service delivery”.

The Auditor-General should have sent his letter to the minister. DHBs cannot attract IT technicians to join an organisation that is being abolished. How can DHBs’ managers reassure “key staff” when their own future is so uncertain?

On July 1 next year the chief executives of the DHBs become third level executives. Why would they stay?

All this pain might be acceptable if mergers to create one massive organisation work.

KPMG, the global accounting firm, says 83 per cent of all mergers fail to provide shareholder value.

The rational for the health reforms is false, the claim that after centralisation your standard of care will no longer depend on your post code. Not only is this impossible to achieve, the health system should not even try.

My neighbour had a stroke. Despite flying her in a helicopter she did not make the magic one hour. She was permanently stricken. Centralisation will not change our geography.

The health dollar is not infinite. DHBs have to prioritise. My DHB prioritises rheumatic fever because it is common in the Bay of Plenty.

How can having one national standard of care but no more money provide better health for the regions? Studies show government commitments made to the regions when centralising are always broken. After centralisation, resources flow to the capital. Managers prioritise what they see.

The main reason centralisation fails is culture, “the way we do things around here”. A centralised organisation has to be command and control with rigid rules. It is a culture that crushes initiative and problem-solving.

The Gibbs report found the least efficient private hospital was more efficient than the most efficient public hospital. The same doctors work in both systems. Doctors in the private sector are empowered to solve problems.

Instead of centralisation the minister should be encouraging DHBs to decentralise decision making empowering their health professionals to find solutions.

The Ministry of Health has advised the Government that its changes will not work. Dr Ashley Bloomfield can give the country advice on Covid but his advice to the Government on health reform is ignored.

The highly politicised Prime Minister’s Department, that has no expertise in health, is driving these catastrophic health changes.

My advice to you dear reader, is not to get sick.

– Richard Prebble is a former leader of the Act Party and former member of the Labour Party.

Source: Read Full Article