Punishing performance

August 5, 2020

The Southern District Health Board could be punished for high performance:

The Southern District Health Board’s hard work to catch up on surgery postponed because of the Covid-19 lockdown may have backfired, as the organisation is still waiting to be told it will be paid for that work.

Without confirmation the Ministry of Health will pay for those operations, the SHDB might need to scale back how many surgeries it carried out to meet financial targets, chief executive Chris Fleming said in a report to the board.

“Other DHBs have delayed their recovery awaiting confirmation of funding, but we do not believe patients should have to wait simply while funding arrangements were sourced as this simply delayed patients further than necessary,” Mr Fleming said.

Doctors warned that cancelling all elective surgery during the lockdown could cost lives. Delaying operations further once the lockdown was lifted would not have been in the best interests of patients.

If we do not receive confirmation of this funding prior to the final audited results being produced, we will need to deteriorate our performance to not impact 2020-21.”

The SDHB quickly put a surgical recovery plan in place after the Covid-19 lockdown lifted.

The ministry had asked all DHBs to attempt to deliver up to 85% of planned surgery in June.

The SDHB, which postponed about 1200 operations during lockdown, not only achieved 100% of target, but also performed an extra 200 operations above target through initiatives such as running weekend clinics.

“This came at an outsourced cost of approximately $1.2 million,” Mr Fleming said.

“We have assumed that the volume in excess of our plan for the month will be able to be recovered from additional planned care revenue.”

However that has not been confirmed, leaving the SDHB’s already parlous finances further stretched — and meaning a question mark remained over whether it should continue to try to clear the backlog of procedures.

But Mr Fleming stood by the SDHB’s “assertive approach” to get as many people’s operations performed as quickly as possible. . . 

The DHB should not be punished for performing as it should for its patients.

Waiting lists for elective surgery can be weeks, and even months, at the best of times.

All of the people whose surgery was delayed would have been living with greater or lesser degrees of pain and/or disability, and/or potentially fatal diseases. Doing operations as soon as possible once the lockdown prohibition was lifted would have improved the quality of life for all those affected. It would have also lengthened lives for some and saved lives of others.

Delaying surgery further for people with debilitating, possibly fatal, conditions would have been inhumane and funding the extra work ought to be a government priority.

It would be much better use of scarce funds than projects that have received handouts through the Provincial Growth Fund‘s ‘treacle-ridden process’:

It’s been three years and despite many, many questions, New Zealanders still have no idea whether the Provincial Growth Fund (PGF) has created the jobs it was intended to, National’s Regional Economic Development spokesperson Michael Woodhouse says.

Even if Shane Jones’ heroic projection of 10,000 jobs is realised, it will come at a cost to taxpayers of about $300,000 per job. This is incredibly poor value for money for taxpayers.

“But not only that, Shane Jones has turned out to be too incompetent to even to hand free taxpayers’ cash to his pet projects. So far, for every dollar committed, just 12.9 cents has been paid out. Even Shane Jones has admitted this is a ‘treacle-riddled process’. . . 

A government that purports to be kind ought to understand that when it comes to surgery to improve, and even save, lives and a treacle-ridden process, there is no contest.

One should be regarded as a core government function. The other is thinly-disguised vote-buying.

 


That’s no way to say goodbye

May 13, 2020

National is threatening to fight Level 2 enforcement law if the rule on tangi and funerals isn’t changed:

Under level 2, only 10 people can attend a tangi or church service at any given time. 

Prime Minister Jacinda Ardern said she, like other world leaders, struggled with the decision, but had to play it safe. . . 

But what’s safe and what’s not doesn’t seem to be consistent.

National Leader Simon Bridges said the public had been writing to him raising the point that people could still go to a restaurant or movies with 100 people at the venue.

Yet at one of the most tragic defining points of life, at a funeral, direct family members cannot attend them under those rules. That’s not just unkind, it’s inhumane, and I think we can do better than that,” he said.

One of the doctors who looked after our son and was there when when he died told us that it was very important to say goodbye properly.

We didn’t know much about funerals and others said it would be best to keep it private.

Tom was only 20 weeks old, had spent almost a third of his life in hospital and few outside the family and hospital staff had met him so we followed that advice.

It was a mistake. We had afternoon tea after the service then our parents and siblings went home leaving us alone with our young daughter and our grief.

We learned from that and when our second son died we had a public service.

It was so much better. Some people left after the service, others stayed to talk, to listen, to comfort us.

That’s how saying goodbye  should be, a service about the one who has died to for the ones who are left, and for most that needs more than 10 people.

Anger and upset over this is made worse by inconsistencies:

Grieving families are distraught over inconsistencies with the COVID-19 alert level 2 rules, baffled that the Government will trust people to go to the movies, gyms and malls but not to farewell friends and whānau. 

Kiwis will be privy to a whole lot of new freedoms on Thursday when the level 2 rules come into play, but it won’t bring satisfaction to the family of Southland man Maurice Skinner, who passed away last week, three months before his 90th birthday. 

A former jockey and racing trainer, Maurice Skinner was a well-known Southland figure, and a funeral could’ve drawn hundreds. But his family just wanted a small private service – 21 people – so they delayed until alert level 2. 

But holding off has left them disappointed because the level 2 rules don’t allow it. 

“We can’t even do that now, so we’re absolutely devastated,” his daughter told Newshub. “One of the worst things you can stop people doing is being able to farewell their loved ones.”

Under level 2 there’s a cap on gatherings – no more than 10 people. And yet, up to 100 people could be in a gym, a restaurant or the movies, as long as they’re socially-distanced. 

In the normal course of events, people would be much closer than two metres and part of comforting the bereaved would be hongi and hugs. But funeral directors and celebrants, as required under health and safety legislation, could make sure that social distancing was maintained.

We know this is causing pain but we equally have tried to be really consistent,” Prime Minister Jacinda Ardern said on Tuesday. 

But it doesn’t feel consistent for grieving families. 

“The Government is telling us we need to be kind but where on earth is the kindness in that? It’s actually inhumane,” Clutha-Southland MP Hamish Walker told Newshub.  . .

Those in mourning want the Government to trust them. 

The woman Newshub spoke to anonymously is from a family of medical professionals including a COVID-19 nurse, and they know full-well how to manage the risks. 

“We can be responsible with our loved ones and the people that are around us – just give us the benefit of the doubt,” she said.  . . 

Ten is a very small number for most families. We had 11 adults and six children at Tom’s private service.

It is possible for far more than 10 to join via electronic communication but that is a very poor second to being there, with the people you care about, albeit two metres apart.

If there was widespread community transmission of Covid-19 the insistence on no more than 10 people at a funeral would be more easily understood.

But there is not.

Yesterday’s ODT reported no new cases of the disease in the Southern District Health Board area for 16 days and the Waitaki District, like several others has recorded no cases at all.

It defies logic that the government trusts casinos, bars and movie theatres to have up to 100 people but no more than 10 at a funeral.

Preventing people from saying goodbye properly is the antithesis of the kindness we’re all exhorted to show.

It’s inhumane and the rule must be relaxed to allow families and whanau to farewell the dead and comfort the living.


Wrong data, wrong result

January 24, 2020

The decision to close the Lumsden Maternity Centre was based on incorrect data:

The Lumsden Maternity Centre was closed last year as part of a region-wide review of maternity services by the Southern District Health Board, and replaced with a maternal and child hub.

The decision was strongly opposed by locals; a report by Ernst and Young commissioned by the board found numerous faults with how the SDHB implemented its maternity strategy.

The report’s terms of reference did not include the SDHB’s decision to create a hub at Lumsden.

That decision was the subject of the new report, which was written by midwifery academic Pauline Dawson and commissioned by Lumsden clinic operators the Northern Southland Medical Trust.

Ms Dawson said the closure went against the aims of the National Maternity Monitoring Group and the SDHB’s own primary health strategy.

‘‘This closure puts mothers and babies in this area at risk of poor short and long-term health outcomes and places additional burden of care on remote rural lead maternity carers.’’

Ms Dawson said when deciding to close Lumsden the SDHB did not correctly identify the catchment area the unit served, and ‘‘significant’’ numbers of mothers who had used it were not counted.

The SDHB had used birth numbers in its reports where it should have considered pregnancy numbers when assessing if it had met its Ministry service coverage schedule requirements, Ms Dawson said.

The Ministry itself used a document to support the decision in which travel times between centres were incorrect, and wrongly used the time to the closest primary facility rather than to a secondary service, as it should have, Ms Dawson said.

There’s a big difference between what’s available at a primary facility and a secondary one.

‘‘This error makes several locations appear as they are within service coverage schedule specifications, when they definitely are not.’’

Trust chairwoman Janese Priergaard-Petersen said the report confirmed many of the issues trustees had raised.

‘‘The decision was based on poor information and then executed poorly by the SDHB.

‘‘We don’t yet have any solid data on outcomes for mothers and babies, both in terms of births and postnatal care but we do know that mothers, and the lead maternity carer midwives who care for them, are struggling with the lack of support left by the closure of Lumsden Maternity.’’ . . .

They don’t have solid data but they do have cases where the lives of the mothers and babies were at risk because the Lumsden Centre had closed.

They include the woman whose husband drove at high speed in winter conditions while she was on all fours in the back seat; and a baby born in a car park outside the centre.

The community has questioned the decision to close the maternity centre from the time it was first mooted.

It was the wrong decision, based on wrong data.


Rural round-up

April 16, 2019

‘M. bovis’ effects force family off farm – Sally Rae:

Graham Hay is preparing to walk off the land his family has farmed for nearly a century.

The Hakataramea Valley property has been in the family since his grandfather took over in 1921 and Mr Hay has lived there all his life.

It is gut-wrenching to hear his voice choking, as he explains how he and his wife Sonja have had no choice but to sell their farm.

Already under financial pressure coming out of an irrigation development phase, he believed they could have farmed through that. . . 

Lessons learned: MPI holds public meeting with farmers – Sally Rae:

Painful lessons have been learned during the Mycoplasma bovis response and hopefully all lessons will be “locked in” and used in the event of another disease incursion, programme director Geoff Gwyn says.

Mr Gwyn was speaking at a public meeting in Oamaru last week, as part of a series of farmer and public meetings throughout the country.

Those meetings came in the wake of the launch of the 2019 Mycoplasma bovis National Plan, released by the Ministry for Primary Industries, DairyNZ and Beef + Lamb New Zealand last week. . . 

Yili bid for Westland Milk raises questions about dairy co-operatives – and Fonterra’s ownership – Point of Order:

On  the face  of  it, it’s  a  no-brainer.  Weighed  down  with  debt,  Westland  Milk,  based in   Hokitika  is financially  on  its  knees.  Riding  to  its  rescue,  Chinese  dairy  giant  Yili  has come in with a  $588m buyout deal   which  will yield  $3.41  a share   to the co-op’s  farmer shareholders,  and, as well,   absorb  Westland’s debt and liabilities.

According to  Westland, the  nominal value of its shares  has ranged  from  70c  to $1.50  per share. For the  average-sized  Westland farm, the  share offer translates to  about half a  million dollars cash.

The offer  looks even  more attractive since  Westland had to  cut its  milk payout  forecast, while other  companies’ forecasts  are rising.  Westland, which has  grown out of  the West  Coast’s  150-year  dairy heritage, hasn’t paid  a  competitive milk price   for  several years. . . 

Lumsden Maternity Centre downgrade may force expectant mothers to travel further

Mothers may be forced to travel further to give birth after a Southland birthing centre was downgraded.

The Southern District Health Board announced the Lumsden Maternity Centre downgrade last August, triggering community outcry, a protest march, petition and appeals to the government.

The centre has become a maternal and child hub where babies are only delivered in an emergency.

The company that ran the centre said mothers travelled from as far away as Queenstown and Te Anau to use the birthing services. . . 

Farmhand’s common sense solution for vegan activism – Andrea Davy:

A YOUNG farmhand has offered up a commonsense approach for stopping the spread of misinformation around Australian farming.

Coming off the back this week’s vegan protests, which rolled out across the nation on Monday, Zoe Carter posted a Facebook live where she called on the industry to “step up” and increase education in schools.

Zoe has more than 140,000 followers online, an audience she has grown through sharing videos and photos from her life working in ag.

In the post, she said the current education system was leaving a huge knowledge gap on how food was produced. And, unfortunately, this space was being filled up with “lies” peddled on social media. . . 

Large-scale highly fertile stock finishing farm for sale:

A highly-productive farm whose grazing stock once produced prized wool used by one of New Zealand’s foremost carpet manufacturers has been placed on the market for sale.

Puketotara, near Huntly in the Waikato, was previously owned by Douglas Bremner – the businessman who founded the legendary Bremworth Carpet brand in 1959. Wool from the Drysdale sheep farmed at Bremner’s Puketotara farm was used in the production of quality carpet manufactured at the company’s mill in South Auckland.

The Bremner family sold the property in 1989, and soon after it was converted into an intensive breeding and finishing farm – stocking beef and sheep and producing cash crops.. . 


Marching for Waitaki’s health services

July 5, 2015

Nearly 30 years ago around 13,000 people marched through Oamaru to protest against proposed cuts to health services.

This morning there’s another march for the same reason and it’s got political.

Dunedin North MP Dr David Clark has been accused of trying to ”hijack” tomorrow’s health march in Oamaru, and has been denied speaking rights after refusing to accept a condition not to criticise the Government.
National Party Waitaki MP Jacqui Dean will speak at the march because she had agreed to that condition, Waitaki Mayor and march organiser Gary Kircher said.

The event was ”not political”.

The focus was the Southern District Health Board and its funding priorities. . .

The Mayor says more in a Facebook post.

. . . As has been clear from the start, this march has been about the cuts to our hospital funding proposed by the Southern DHB. Instead, David wants to make it political by bringing in the much wider issue of government funding and he wants to use our march to make his political statement.
Now, we all would love for central government to put more money into health, but the SDHB has had increases and they’re simply not passing on our fair share to us in Waitaki. They haven’t done so for years. Instead, we had no increase last year and they want to cut 5% from our funding this year! They would rather make our people go to Dunedin for services which we can deliver far more efficiently in Oamaru! For example, we have excellent scanning equipment and services in Oamaru Hospital but we only get around $15,000 per year to run them. People complain that they have to go to Dunedin for scans when they could be done right here! However, David doesn’t want to focus on this. Perhaps it’s because many of the Dunedin Hospital staff who benefit from this wasteful spending live in his electorate?
I have made the offer to David that he can march alongside me and our Councillors at the front of the march, I’ve told him that I will acknowledge him and his support for the aim of our march in my speech, and I had intend to have him up on the stage with the speakers and our Councillors. And I had offered to let him speak if he focussed on the reason for the march. But if he really prefers to let the DHB off the hook by playing politics, I make no apology for declining his last-minute request to speak.  . .

There is a legitimate argument about whether the population based funding model is calculated correctly for large areas with smaller and older populations but that is an argument for another day.

Today is not about whether the south’s share of the health cake is big enough but because Waitaki is not getting it’s fair share of the south’s slice.

Waitaki District Health Services chair George Berry puts the board’s case here.

 


Commissioner for SDHB

June 18, 2015

Health Minister Jonathan Coleman has appointed a commissioner to replace the Southern District Health Board.

The financial problems at Southern DHB are longstanding. I do not have confidence that the current governance arrangements are suitable for delivering on the changes required in Southern DHB,” says Dr Coleman.

“Southern is forecasting a final deficit of $27 million for the current financial year. That figure has effectively doubled in the last six months.

“The DHB has also forecast that its deficit position will further increase in 2015/16 to between $30 million and $42 million – this accounts for over half the combined deficit of all 20 DHBs. This situation of fluctuating forecasts and progressively worsening deficits cannot continue.

“The Government is committed to the redevelopment of Dunedin Hospital and the provision of high quality health services to all the people of the Southern region.

“All DHBs are funded according to the same population-based funding formula. This formula includes adjustments to recognise rural populations, age and other demographic issues.

“In a tight fiscal environment, all DHBs need to use available funding effectively. No other DHB has failed to control its finances in the way that Southern has.”

Kathy Grant has been appointed Commissioner and takes up the role on 18 June 2015. After discussions with Mrs Grant, she has indicated that she intends to appoint Graham Crombie and Richard Thomson as deputies. A third deputy with a strong clinical background will be appointed by the end of the month.

“Mrs Grant is from Otago and brings significant local knowledge. She has significant business and governance experience and a proven track record in turning around struggling organisations,” says Dr Coleman.

“The team will bring together a mix of strong financial, governance and clinical skills.

“I would like to thank the Board members for their work to date. My decision is not intended to devalue their efforts and achievements. However, a new approach is now necessary.

“My decision is based on the need for a new approach to the DHB’s longstanding financial issues, and to help move the DHB to a more sustainable position over time.”

This is a good move by the minister and the commissioner has made a very good start in the appointment of her deputies:

Kathy Grant bio
Kathy Grant was born in Otago and has spent most of her life in the region.

Mrs Grant currently works as a consultant in the legal practice of Gallaway Cook Allan in Dunedin. She has significant governance experience. Mrs Grant holds several current directorships including Chair of the Otago Polytechnic Council (appointed 2010), a trustee of Sport Otago (appointed 2007), and a director of Dunedin City Holdings Ltd (appointed 2012), Dunedin City Treasury Ltd (appointed 2013), and Dunedin International Airport Ltd (appointed 2008). She was also a member of the Anglican Family Care Board (2009-2013).

Mrs Grant has been on the Board of Trustees for several schools and colleges, and a previous member of the University of Otago Council (2007-2010). She was also previously Chair of the Dunedin College of Education Council (2001-2006).

Graham Crombie bio
Graham Crombie is a Dunedin local. He attended Bayfield High School and Otago University. Mr Crombie has a strong background in accountancy, with a proven record in high level assessments of the sustainability of health organisations. He was President of the New Zealand Institute of Chartered Accountants (2008) and went on to become chair of the organisation (2009-2014).

Mr Crombie also has lengthy governance experience. He is currently chair of Dunedin City Holdings (appointed 2012), Dunedin City Treasury (appointed 2013), Otago Museum Trust Board (appointed 2011), Dunedin Venues (appointed 2015) and director of Surf Life Saving NZ (appointed 2013). He was also the independent chair of South Link Health (1999-2009).

Richard Thomson bio
Richard Thomson was born in Invercargill and attended Otago University. After specialising as a Clinical Psychologist he took up a lecturer role at Otago Medical School. He is now a successful businessman.

Mr Thomson has key insights into Southern DHB. He was chair of Otago DHB (2001-2009) and became a Board member after Otago DHB merged with Southland DHB (2009-2015).

Mr Thomson is currently serving his second term on the Dunedin City Council.

They have a difficult job to do but it must be done to secure health services in the south.

All DHBs have population based funding which takes into account a variety of factors.

Advocates in the south have long-argued that the formula doesn’t take enough account of the costs of servicing a smaller population, which isn’t growing much and is older than the average, spread over a large area.

The ODT editorialises:

. . . The fairness of the opaque population-based funding model again has to be questioned. The South failed to attract the increases of other areas in recent times and for various reasons could be seriously disadvantaged.

If the appointment of a commissioner is the signal for a fresh start then everything should be on the table, including how funding is calculated with an analysis of its fairness. After all, the South has to cope with the largest geographic area, the extra costs for teaching and many – and usually more costly – older patients. . .

The commissioner and her deputies will have to make the formula work or prove the advocates right.

 


Commissioner for SDHB?

June 9, 2015

The Southern District Health Board may be replaced by a Commissioner:

The board has until Thursday to respond to Health Minister Dr Jonathan Coleman’s proposal to consider appointing a commissioner under the New Zealand Public Health and Disability Act, it was revealed yesterday.

A commissioner would have the powers and functions of the board, except for procedural aspects relating to meetings, a letter from Dr Coleman to chairman Joe Butterfield says.

”Based on the board’s previous history of failure to deliver on its annual plan expectations, I do not have confidence that the current governance arrangements are suitable for overseeing the strategic plan or delivering on the changes required in Southern DHB,” he wrote. . .

The SDHB might not like this but the boards of the smaller hospitals it funds will be relieved.

The proposed action follows months of uncertainty after Dr Coleman confirmed in February he wanted to replace Mr Butterfield with a new chairman, but no appointment was made.

In the meantime, proposed cuts to head off a projected $42million deficit in 2015-16 met opposition and put pressure on Dr Coleman and local National MPs.

About 1700 people attended meetings in Central Otago last month to protest against possible reductions to Dunstan Hospital services.

George Berry, chair of Waitaki District Health Services said the proposed cuts would result in a serious downgrade of Oamaru Hospital.

The cuts to funding of Oamaru, Dunstan, Balclutha and Gore hospitals would be serious for them and make only a small difference to the SDHB’s deficit.

They’d also add to costs in Dunedin Hospital when patients unable to be treated locally were transferred to the city.

I was deputy chair of WDHS from its formation in 1998 until 2005.

It and the boards of the other rural hospitals have had an on-going struggle to get their fair share of funds and the financial situation of the SDHB has deteriorated.

Sacking the board and replacing it with a commissioner is a serious step but one which must be taken for the security of health services in the south.

 

 

 

 

 

 

 

 

 


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