Obvious truths about the healthcare system | Exclusive News


February 1 business office published an article by me on two self-evident truths in the Aotearoa New Zealand healthcare system. One was the deplorable neglect of labor shortages (especially health professionals) and the other was the decision to abolish District Health Boards (DHBs) an undeclared state of emergency

My use of the term “self-evident truths” comes from the Declaration of Independence adopted in 1776 by the 13 British colonies on what is now the eastern seaboard of the United States. The Declaration includes the powerful words “all men
[sic] are created equal” with certain “inalienable” rights including life, liberty and the pursuit of happiness. This equality and these rights do not need to be developed further because they are taken for granted.

The first evidence: the labor shortage

The first obvious truth is the importance of healthcare personnel to DHBs. These are not just doctors and nurses, but a range of other qualified healthcare professionals, including laboratory scientists, physiotherapists and occupational therapists, radiation therapists, psychologists and physiologists. Then there are also the administrative staff, housekeepers and others on whom the health professionals depend.

These are the people who make the health system work and add value to its performance and efficiency. They are the basis of a huge amount of intellectual human capital which, if allowed to be funded and used for improving systems rather than just diagnosing and treating patients, can dramatically improve assessment. health care, quality of health care and fiscal performance of DHBs. .

Instead, we have the opposite. We have severe shortages of healthcare professionals leaving behind an overworked and overstretched workforce struggling to cope. The workforce is tired at best and exhausted at worst. It is dangerous not only for the workforce, which pays for it with its health. It is dangerous for the patients.

The fact that this is the result of nine years of neglect by a national government and more than four years of neglect by a Labor government does not lessen the latter’s irresponsibility. Labor knew what they had inherited and chose to continue rather than remedy this neglect (except when pushed hard by nurses’ strikes). This makes Labor as guilty as the National.

In my business office
article I have concluded with regard to obvious truth labor that:

The obvious ugly truth is that this government’s failure (compounding the failure of its predecessor) to address severe labor shortages despite its tenure since October 2017 is responsible for the fact that the neo-healthcare system Zeeland is in an undeclared state of emergency now that omicron has arrived.

Obvious Truth Two: Restructuring in Times of Pandemic

Health Minister Andrew Little introduced the Pae Ora (Heathy Futures) Bill in Parliament. The bill includes two proposals which I strongly support – the creation of the Maori Health Authority and a new public health agency. These are not new ideas. The principles behind them have been widely discussed and debated for many years. Their time has come.

The same cannot be said for a third proposal, the removal of DHBs. This was not part of Labour’s 2020 election manifesto (quite the contrary) and was not part of any previous debate. The strongest advocates appear to be Ernst & Young (EY) business consultants who are at the helm of the Transition Unit set up to implement government restructuring. The unit is led by EY Senior Partner Stephen McKernan.

International Uniqueness of DHBs

DHBs were established in 2001. Apart from a brief interlude with regional health boards in the late 1980s and early 1990s, this was the first time that statutory bodies were created to be responsible for health and well-being of geographically defined populations and integration between communities. (including general medicine and residential care for the elderly) and hospital care.

This full responsibility across the health spectrum has been a strength of our public health system ever since. This includes the obligation to “regularly investigate, assess and monitor the health status of its resident population”.

Structurally, this has given New Zealand significant advantages over many other modern health systems where, for different reasons, community and hospital care are much less integrated as they are more structurally separate.

In fact, the structure of the DHBs is well placed to better contribute to the efficiency of the Maori Health Authority and the crown of the public health agency. These two new bodies resonate philosophically and operationally with DHBs who know their own defined populations.

DHB and vaccine deployment

A careful review of international data confirms that DHBs have been very successful in vaccine deployment. New Zealand’s full vaccination rate is one of the highest in the world. It was even higher than the European Union which had the enormous advantage of being able to negotiate as a powerful collective bloc with the monopoly pharmaceutical companies and of having vaccine-producing countries among its members.

The particularity of having statutory local structures responsible for geographically defined populations has proven to be a major factor in this success. Although they had no control over the supply, DHBs were able to offset our big disadvantage as a small economy far from vaccine-producing countries.

Earlier in the rollout, some DHBs were criticized. But the fact is that the comparative achievements of DHBs have been ranked according to the size of the workforce and population density.

The larger the numbers of DHBs and the denser their population, the sooner they reach vaccination milestones. These were the DHBs with a smaller workforce and lower population density due to rural communities which were comparatively slower.

Omicron Threat

The omicron variant of Covid-19 will put the entire country’s healthcare system under unprecedented dangerous pressure, especially our public hospitals. The impact will no longer be confined to one region.

Transmission will be too high and too fast to prevent the increase in hospitalizations. This will likely increase death rates. Hospitals already facing severe labor shortages are also likely to be mired in a “long covid” where the effects of the virus continue for weeks or months beyond the initial illness.

It’s much more likely than not that omicron won’t be the last Covid-19 variant this year. Some of its successors will be less virulent and others more virulent.

Political oscillations

Many members of the healthcare system are acutely aware of the risks of discontinuing DHBs during a pandemic. But in this controlled and predetermined environment, it is difficult to raise these concerns, let alone openly. On the rare occasions when these risks are voiced internally, McKernan in particular has been known to address those affected rather like a verbal ton of bricks.

The New Zealand Medical Association, after raising concerns at the select committee hearing the bill, received a reprimanding call from the office of the Minister of Health. Very unprofessional attempt at intimidation.

There are, however, political sensitivities within the government. Health Minister Little has decided to offer DHB Chief Executives the right to continue in their current jobs for three months after the planned abolition of DHB (i.e. from July 1) with a right renewal for three additional months until the end of the year.

This was opposed by McKernan of EY but Little rejected his advice. However, this decision incorrectly assumes that the general managers are the DHBs when they are simply the operational head of what lies below them. It is the functions of the DHBs that are important, not the head of their operational structure.

Moreover, few have been more devalued, scorned and scapegoated by the restructuring process and those leading its implementation than the chief executives of DHB. They are now being asked to help minimize risk. Most of the time they are disappointed. Few are expected to accept the “offer”; not those who already have other things to do or who do not wish to be associated with this new system.

Height of leadership incompetence and irresponsibility

Abolishing DHBs is a mistake and will be counterproductive. The loss of statutory bodies that are familiar with their defined populations compared to a national body will reduce the efficiency of the health system. It is compounded by the fact that there are few ideas other than “prototypes” of what will replace the community care functions of the DHBs.

But, in addition, doing this during a still ongoing pandemic is not only incompetent; it’s dangerous. It’s dangerous for patients, for those who work in the healthcare system (especially those involved in treatment).

In my
business office article the penultimate paragraph concludes:

So what is the government doing? In the midst of this calamity, he abolishes the bodies responsible for the health and welfare of their defined populations, including public hospitals. The second ugly evidence is that the restructuring of the health system in the midst of a pandemic is not just madness; it is the height of incompetence and irresponsibility of leadership.

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