Hope he’s standing for right reasons

October 4, 2010

When Otago District Health Board employee Michael Swann was found guilty of a $17m fraud, Health Minister Tony Ryall held board chair Richard Thomson responsible and sacked him.

Thomson was elected to the board, chose to stay on as a member and is a candidate in the current election for what is now the Southern District Health Board which was formed when the Otago and Southland DHB’s amalgamated.

I have no doubt he’ll get back on and I wouldn’t be at all surprised if he tops the poll.

I just hope he’s standing because he can make a positive contribution to the board and health services in the south and not in a misguided attempt to give the fingers to the minister.


Health Boards’ merger less certain

December 15, 2009

Otago and Southland District Health Boards have been developing a closer relationship for some time.

They have a single chief executive and chair and have been consulting on a full merger.

Public meetings on the proposal haven’t been well attended which indicates people don’t have strong feelings on the issue.

The most heat about the the proposal was from Central Otago where people who are caught between board boundaries were in favour of the merge. They gave the example of someone in Queenstown who needs chemotherapy who has to go to Invercargill under the current structure but would be able to make the shorter journey to Dunstan Hospital if there was a single board.

However, Southland Hospital doctors wrote an open letter opposing the merger, just a day before submissions closed.

Dr Charles Lueker, who chairs the senior medical staff committee in Southland, said the letter was signed on behalf of “well over 90%” of senior doctors at Southland Hospital.

The doctors expressed concerns about services being centralised to Dunedin and the loss of the board’s advocacy for the people of Southland.

Reducing costs, sharing resources and providing more convenient service for many rural patients has a lot to recommend it.

It would be a pity if the merger which would do this was to fail at this late stage.


Southern DHBs to merge

October 11, 2009

The Otago and Southland District Health Boards are expected to merge.

The boards have been working closely together with some members from each sitting on both. A merger is the logical next step.

A merger of the Otago and Southland district health boards would immediately save a minimum of $500,000, with savings of at least $1 million expected longer term as duplication of board and committee meetings was cut, ODHB chairman Errol Millar said last night.

 It will also mean better service and some choice for patients, especially in Central Otago.

Cancer patients from Queenstown have to travel to Invercargill for chemotherapy treatment even though it could be provided at Clyde Hospital which is closer because Queenstown is covered by the SDHB and Clyde is under the ODHB. When the boards merge this sort of bureaucratic line drawing will stop.

The merge might persuade neighbouring boards in other areas to join forces too. Twenty one district health boards for a population of 4 million is administration overkill and a ridiculous waste of time, energy and money.


You’ve gotta know when to hold up . . .

February 19, 2009

. . . know when to fold up, know when to walk away . . .

dairy-1

Garrick Tremain’s cartoon, printed several days ago, shows that then Otago District Health Board chair Richard Thomson didn’t heed the words of the Gambler.

He didn’t accept the invitation to walk so Health Minister Tony Ryall relieved him of his chairmanship.

The ODT doesn’t agree  with that decision:

While Mr Ryall’s demands for accountability are understandable, he picked the wrong scapegoat.

. . . It was other executives and senior staff who, surely, carried far more responsibility, particularly because warnings about Swann were not passed on.

But the Minister of Health has no control over any of these people so is it possible he’s using  one of few weapons in his armoury – the right to appoint, and disappoint, the chair – to encourage the board to take further action which he can’t?

The Minister of Corrections Judith Collins is similarly constrained over the continuing employment of Barry Matthews in spite of a damning report from the auditor general about the department he heads. He is answerable to her but she is not his employer so it is up to the State Services Commission to sack him, or not.

The Prime Minister supports his minister  :

“The New Zealand public is entitled to expect accountability, and quite frankly, that report made such damning reading they can have no confidence at this point that the department is following an approved set of procedures that they promised they would follow.”

The operative word is accountability.

It’s not blame or responsibility, and anyone with the ability to chair a board or lead a government department ought to understand that, and to know that it is better to fold up and walk with dignity than to wait to have your cards taken from you.


DHB fraud fallout highlights stupidity of Clayton’s democracy

February 17, 2009

Otago District Health Board chairman Richard Thomson didn’t accept the invitation to jump so Health Minister Tony Ryall has pushed him

No-one is saying Thomson is responsible for the $17 million fraud for which former ODHB employee Michael Swann and his and business associate Kerry Harford were found gulty last year.

But Ryall is holding him accountable  and had he understood his role and responsibilities as chair he’d have resigned before he was sacked.

David Farrar Kiwiblog explains the requirement for accountability at Kiwiblog and in his NBR column.

The letters page of the ODT has had a lot of correspondence on the issue, some of those in support of Thomson point out he was elected to the board, not appointed.

That is irrelevant and just highlights the stupidity of the Clayton’s democracy surrounding DHB elections because, elected or appointed ,health boards and their members are accountable not to their communities but the Minister.

Because he’s elected, Thomson could choose to stay on as a board member now he’s been sacked as chair. But if he didn’t understand why, although he was neither to blame nor responsible for the fraud, he should still have been accountable for it; he’s shown he doesn’t understand the role of the board and to whom it’s answerable.


$16.9m fraud against ODHB

December 8, 2008

Michael Swann and Kerry Harford have been found guilty of defrauding the Otago District Health Board of $16.9m.

The ODT backgrounds what is thought to be the largest fraud against a government instituion.

Its editorial asks about the duty of care the ODHB and its predecessor Healthcare Otago had to prevent the fraud or uncover it sooner.

And Health Minister Tony Ryall has called for urgent confirmation systems are in place  to prevent fraud in all DHBs.

Large organisations have to trust their employees, but they also need systems to ensure that their trust is not misplaced.


Key firm on 100 day programme

December 6, 2008

John Key told the ODT he’s determined to implement the 100 day programme  the National party campaigned on.

That includes the tax package, RMA reform, literacy and numeracy standards in education and he also wants more accountability in health:

The Ministry of Health and district health boards would be instructed to halt the growth in health bureaucracy and open their books on the true state of hospital waiting lists and the crisis in services.

The opening of books won’t be pretty if yesterday’s story from the Otago District Health Board is anything to go on. It’s facing a $13 million deficit.


Sharing CEO sensible step

October 4, 2008

The appointment of a single chief executive for the Otago and Southland DIstrict Health Boards is a very sensible step.

Brian Rousseau who was the Otago CEO and has been interim CEO for Southland since last year will take on the joint role which is a first for district health board management.

The chairmen of both boards say the appointment enhances the strong commitment to regional collaboration over services, but neither is suggesting the boards should amalgamate.

I think that would be a sensible aim. There would be economies of scale and it would be welcomed by the many people on the heath board borders who want to use Dunedin services but have to use Southland’s and vice versa.

Otago chair Richard Thomsom said:

The appointment did not change anything fundamentally for the boards, but would make it easier to further develop a regional focus on services.

“As Brian would say, it’s difficult to argue with yourself when you’re the CEO of both boards.”

The boards have two services in common, Southern Blood and Cancer and cardiac surgery, and several senior management staff work across both organisations.

Two of the boards’ advisory committees share membership.

Southland chairman Dennis Cairns said the boards faced the problem of catering for populations spread over a large area.

The average number of health service users over the country per square kilometre was 13.1, compared with 5.6 in Otago and 2.8 in Southland.

In an area such as Counties Manukau there could be one hospital catering for 250,000 people, but in Otago and Southland there were seven hospitals.

It’s always going to be more expensive to treat people scattered over a large area than if they’re concentrated in one place. A closer working relationship between Otago and Southland ought to ensure that less is spent on overheads leaving more for services.

The Southland Times’ report is here.


ODHB $6m overbudget for overtime

September 13, 2008

Staff shrotages has led to a $6m overspend in the Otago District Health Board’s overtime budget in the past three years.

A 400% budget blowout in overtime during the past three years, from $1.5 million to $7.4 million, is directly related to vacancies at the Otago District Health Board, chief operating officer Vivian Blake says.

Figures supplied in response to a request from the Otago Daily Times showed overtime payments for nurses and medical staff were over budget by almost $6 million for the past three financial years.

“It is expensive for the district health board and not good for staff to continue to work over their normal hours.”

It’s also a viscious circle – staff shrotages mean existing staff have to work longer hours which makes recruitment and retention difficult which leads to staff shortages…

The problem isn’t peculiar to Dunedin or New Zealand, but our knowledge wave exports – that’s waving goodbye to skilled people – doesn’t help.


Policy root of DHB problem

September 5, 2008

The Otago District Health Board faces cost cutting because of a budgeted deficit of $7.3 million.

At the root of this problem is the wrong assumption that Otago was over-funded.

Population-based funding is good in theory and may even work in practice when adjustments are made for factors such as age and rurality providing it is based on realistic budgets.

But when it was introduced the Minsitry of Health started by saying Otago was over funded and required it to reduce costs. Instead of working out how to bring other areas up to Otago’s standards, the bureaucrats told Otago it had to get down to the lower cost per person ratio in other areas and the board has been trying to do more with less ever since.

Over funding was simply a bureaucratic judgement based on a wrong assumption. The deficit Otago is now facing and services like the Otago Community Hopsice and Plunket complaining they haven’t got enough money to provide their services are evidence of that.


No pay rise for non-DHB staff

August 27, 2008

Oamaru Hospital support workers are missing out on a pay rise because the Ministry of Health doesn’t recognise that staff at smaller hospitals aren’t employed by District Health Boards.

Last year the Ministry of Health provided DHBs with funds to boost wages for low paid staff but gave only enough to pay DHBs’ direct employees.

Unfortunately for Oamaru Hospital staff they are not direct employees of a DHB. They are employed by Compass Group which is contracted by Waitaki District Health Services and WDHS is contracted and funded by the Otago District Health Board.

This is not the first time Oamaru staff have been disadvantaged by the Ministry providing funds for DHB employees but not those at hospitals contracted to a DHB. Nurses missed out on Multi Employer Collective Agreement rates for the same reason in 2003.

I was deputy chair of WDHS at the time and remember the frustration as we wanted to work with staff to pressure the ODHB, ministry and government for more money. But the Employment relations Act stopped us from talking to staff directly, so we had to work through the union which called a strike.

Eventually the ODHB agreed to fund WDHS to meet MECA rates for nurses even though it wasn’t funded by the Ministry. However, someone didn’t learn the lesson and now Oamaru support staff – cleaners, kitchen workers, orderlies and security – are missing out on pay rises given to people doing the same jobs at other hospitals.

The Ministry doesn’t appear to realise how health services work down here. When what was then Healthcare Otago announced it was pulling out of rural hopsitals a decade ago the Waitaki District Council leaped into the breach and formed a Local Authority Trading Enterprise – WDHS – to run the hospital. It’s the only LATE operating a hospital and it’s been doing so successfully for 10 years except for the on-going problem over funding because the ODHB doesn’t get additional funds for staff not in its direct employment.

The charitable interpretation is that it’s bureaucratic blindness which prevents the Ministry from understanding that we do things differently in the provinces. A more cynical view is that its political ideology which won’t accept that publicly funded private hospitals work. But whatever the cause its the staff who miss out on pay increases.


Cost of dying too high

August 13, 2008

Otago Community Hospice  has received offers of fundraising help since it announced on Monday the deficit it was facing would force it to reduce services.

But Chief Executive Ginny Green said inadequatre Government funding would continue to be a problem.

Several offers of support followed an announcement on Monday the hospice would be closing four beds and day respite care services, as it faces a $300,000 deficit going into the next financial year.

Government funding, given through the Otago District Health Board, had not kept pace with increasing wage costs and rising patient numbers at the hospice, and the shortfall raised by the community was already more than $1 million, Ms Green said.

If the community did rally to raise the $300,000 deficit, the board would have to carefully consider the next step, as the following year it would likely be in the same situation with a $500,000 deficit, she said.

“The fundamental issue is that government is not funding us appropriately and the community has already contributed so much.”

There will never be enough money for health and hospices don’t expect all their costs to be covered by public funding. But when the gap between that funding and costs is so big it threatens the invaluable services they provide for terminally ill people and their families the solution requires more than philanthropy.


Radical thought – put patients first

August 8, 2008

Now here’s a radical thought – Dunedin Hopsital’s emergency department wants to put patients first.

The simple premise of putting the patient first may help to fix Dunedin Hospital’s emergency department woes and save up to 50% wastage at the hospital, the Otago District Health Board was told yesterday.

Emergency specialist Dr Tim Kerruish asked the board not to make any radical changes in the emergency department until a pilot project to increase efficiency and optimise “patient flow” through the hospital had been given a chance.

The project is based on car manufacturing company Toyota’s way of thinking, which involves putting the customer – or in the hospital’s case, the patient – first, as well as looking at how the entire hospital system works and getting everybody working together.

Aiming for perfect patient care should underpin how and why everything was done at the hospital, Dr Kerruish said.

Wastage in hospitals was also “extraordinary” and common estimates of 40% to 50% wastage were probably applicable to Dunedin Hospital, he said.

Otago is one of two district health boards which are trialling the “Optimising the Patient Journey” project in their emergency departments.

I spent a lot of time in Dunedin Hopsital, sometimes more than a week at a time,  when my children were young. That is now a couple of decades ago, however more recent experiences of family and friends indicate that some things haven’t changed: the staff are wonderful but the system needs radical surgery.

Wary as I am of catch-phrases, the thinking behind “optimising the patient journey” sounds like a good idea for staff and patients. Especially as Dr Kerruish said it would come from staff generating ideas and solutions and did not require more resources.

Similar projects adopted in hospitals in United States and the United Kingdom had shown incredible achievements, Dr Kerruish said. Getting everybody working together would be crucial to the success of the project.

“The emergency department cannot fix its problems without help from the rest of the system. This includes GPs and other hospitals.”

For example, emergency department overcrowding was often the result of patients not being able to be transferred to wards which were full because ward patients had not been discharged early in the day.

My baby son had been a patient for about 10 days when I was told he’d be discharged “tomorrow”. When tomorrow came we waited all day for the consultant to come so we could go. By the time he got to us it was early evening but it was the middle of winter and we were 120 kilometres from home so he said it would be safer for us to stay another night. It was early afternoon the following day before we finally left – so we spent nearly a day and a half longer than we should have and the hospital had incurred the extra cost of that.

Another common problem was the way things were done often went back “years and years” and had never changed.

“We never take anything away . . . we just add it to it. We end up with this very complicated system and a lot of the time people don’t know why they’re doing stuff.”

Overseas experience showed staff bought into ideas when they could fix the “Why do I have to do this?” frustrations, Dr Kerruish said.

Putting patients first, simplifying the system, improving co-operation between departments, GPs and other hopsitals and allowing staff to fix the problems doesn’t sound difficult or expensive. I’m sure the friend’s daughter who spent all yesterday afternoon waiting in the emergency department would think it’s worth a try.


Yes Minister approach to funding

July 30, 2008

Yes-Minister  approach to funding means Dunedin women are not getting treatment for post-natal depression.

Women with postnatal depression in Dunedin are missing out on support because a $140,000 service which should have gone ahead last September has not received Otago District Health Board funding, Plunket says.

Plunket Society operations manager for Otago-Southland Barb Long says lack of the service, which will proceed only in a limited way next year with private funding, is a huge gap in services.

She said the society, which had been identified by the board as the preferred provider for the service last July, was only advised in May that the board would not be funding it.

Board chairman Richard Thomson said while he understood Ms Long’s disappointment, it would have been irresponsible for the board to introduce services it could not fund in the long term.

He describes the board as being stuck in a “Yes, Minister” situation (a reference to a British television programme which highlighted the foibles of bureaucracy) where it may get money to start up a service but not be funded to sustain it.

This is not the only Yes-Minsiter aproach to funding in the region.

Oamaru Hospital bought a CT scanner last year but the ODHB which holds the contract for scans will not pass over payment for North Otago patients. This means North Otago patients who qualify for ACC are getting scans locally but other people have to travel to Dunedin Hospital for publicly funded scans or pay to have them in Oamaru.

This is a ridiculous situation when Oamaru has the equipment and the expertise to provide the service while Dunedin has a waiting list for scans and it is a three hour return journey from Oamaru to the city. 

If people require a scan funding shouldn’t be dependent on where they get it.


Health Workers Should Lose Right to Strike

July 11, 2008

Otago District Health Board Chief Medical Officer Richard Bunton  says health workers, like police, should lose their right to strike.

He is commenting on the release of investigations by Health & DIsability Commissioner Ron Paterson into complaints over two deaths during the 20006 strike by medical radiation technologists, on which I blogged yesterday.

Mr Bunton said changing the system “has to happen” so that health service workers were covered by legislation, like police officers and not be allowed to strike.

He would expect the definition of health services to be fairly broad, covering any health work which was essential for delivering good patient care.  It would be a matter of “sitting down and working out a mechanism to settle salaries”.

I am sure this would have public support but at least one union isn’t keen.

Association of Salaried Medical Specialists executive director Ian Powell said Mr Bunton’s suggestion was ” throwing the baby out with the bath water”.

Mr Bunton said he accepted that his views would be controversial and would be met with an “interesting debate”.

It was rubbish to suggest strikes did not affect patient care.

No matter what words or niceties were used to explain what happened during strikes, there was no way that staff could deliver the same level of care when the usual processes and checks and balances were not there, he said.

They also cause extra work and put additional strain on alreay overstretched colleagues who aren’t on strike.

Mr Bunton said it was likely situations similar to those in Dunedin Hospital had occurred elsewhere. If Mr Paterson, the watchdog of patient rights, was making a strong statement about the risks to patients during strikes, the Government was obliged to “have a damn good look at it”.

Speaking from the United Kingdom, Mr Powell said Mr Bunton’s suggestion was not helpful. It would involve going “down to an arbitrationist system”, which he did not believe would be favoured by health workers.

Some perspective was needed about industrial action in the health sector. While there was a perception health was riddled with strikes, that was not the case.

 Mr Paterson was raising pertinent questions which should be considered by the health sector in general – not just the minister – but such consideration should not be a “knee-jerk” reaction, Mr Powell said.

The system doesn’t have to be riddled with strikes for striking to cause an unacceptable level of risk.


Should Medics Be Able To Strike?

July 10, 2008

A damning report  on two deaths which occurred because of delays to treatment during a medical radiation technologists’ strike raises the question of whether health professionals should be able to take that sort of industrial action.

A report into a complaint against the Otago District Health Board involving a Dunedin Hospital patient whose treatment was delayed because of strikes suggested “the wrong party is in the dock”.

The report is one of two by Health and Disability Commissioner Ron Paterson on two complaints against the board, arising out of medical radiation technologists (MRT) strikes in 2006.

It says although there is potential to breach an agreement with unions over life-preserving services, hospitals cannot allow patient safety to be jeopardised.

The reports draw attention to the risks to patients during health professionals’ strikes when clinicians are not able to carry out their usual practices, and calls for the Minister of Health to consider better protection for patients during strikes.

Strikes by any other workers may disrupt and annoy people, but those by health professionals have the potential to kill them.

Read the rest of this entry »


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