“The health system will always be limited”, says the boss of the DHB

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  • Chris Fleming says it was stories about patient harm that kept him awake at night during his tenure as chief executive of the Southern District Health Board.
  • He stands by his decision to downgrade Lumsden Maternity Center.
  • Fleming says there will always be a need for charity hospitals in New Zealand because the healthcare system is rationed.

The resignation of Southern District Health Board chief executive Chris Fleming coincided with the abolition of district health boards, and he says Southlanders need to speak up to ensure their needs are met in the future. reports Louisa Steyl.

The former Southland health boss wished he could tackle the region’s GP crisis and nursing shortage before quitting his job.

He would also have liked to see more progress on the construction of Dunedin’s new hospital and less red tape to get infrastructure projects approved like the ED expansion at Southland Hospital.

Former Southern District Health chief executive Chris Fleming stepped down last week, marking the end of a 30-year career in health care.

The job has been his toughest by far, he says, and there is still a long way to go to improve services in Southland and Otago.

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“It’s the one DHB that has it all,” says Fleming, referring to the scale and complexity of services provided in the district.

A road trip around the district is 750km and there are more people here living more than two hours from a hospital than anywhere else in the country.

Residents live in small groups far apart and providing services close to home is sometimes expensive.

But the DHB was funded based on the number of people it supports and with just 330,000 residents, the district lacks the population mass to meet its geographic challenges, Fleming says.

He’s somewhat disappointed that he hasn’t been able to fully resolve the district’s fiscal issues over the past six years, but pragmatically there was little he could do without compromising patient care, he says.

“The underlying factor is the underfunding of the [health] sector.”

Former Southern District Health Board chief executive Chris Fleming, left, former chief medical officer Nigel Millar and Southern Partnership Group chairman Peter Hodgson during a benediction ceremony at the Dunedin Cadbury factory in 2020 before that it is demolished to make way for the new hospital in Dunedin.  Fleming says the hospital's outpatient building is set to open in 2025.

Hamish McNeilly / Stuff

Former Southern District Health Board chief executive Chris Fleming, left, former chief medical officer Nigel Millar and Southern Partnership Group chairman Peter Hodgson during a benediction ceremony at the Dunedin Cadbury factory in 2020 before that it is demolished to make way for the new hospital in Dunedin. Fleming says the hospital’s outpatient building is set to open in 2025.

Years of underfunding in New Zealand’s health system have forced DHB to continue to invest in improvements and cover rising medical costs for a growing population while trying to reduce a deficit.

When he joined DHB in 2016, then-Health Minister Jonathan Coleman had just sacked the entire board and replaced it with a commissioner over a deficit that was expected to explode to between 30 and $42 million.

Southland and Otago accounted for 160% of New Zealand’s total DHB deficit at the time.

These days, it’s around 3-4% with a cumulative shortfall of $21.863 million in June as it grapples with Covid-19-related costs, staffing shortages and outsourcing.

Although he knows that people want services closer to home, someone must have the “courage to come up with a national plan” for health care delivery that is “realistic about money” and limited staff and infrastructure, says Fleming.

He means that in some cases it is too expensive to offer specialized treatment in too many places.

In other cases, it means moving services around, so that they are more evenly distributed.

The northern Southland community protested for Lumsden Maternity Center to remain open as a primary birthing unit in 2018. Former Southern District Health Board chief executive Chris Fleming stands by the decision.

John Hawkins / Stuff

The northern Southland community protested for Lumsden Maternity Center to remain open as a primary birthing unit in 2018. Former Southern District Health Board chief executive Chris Fleming stands by the decision .

That was the thinking behind the DHB’s controversial decision to downgrade Lumsden Maternity Centre.

Fleming is sticking to the decision, despite the heavy criticism and opposition he has received from communities in northern and western Southland.

“In an ideal world, we would have primary birth units everywhere.”

But having three primary birth units close to each other (in Lumsden, Winton and Gore) didn’t make sense when there were none in Wānaka, he says.

It is this rationed nature of New Zealand’s healthcare system that also makes Fleming believe that Southlanders should be grateful to the community-funded Southland Charity Hospital, rather than seeing it “as a blight” on the healthcare system. health.

Under his leadership, the Southern DHB was committed to supporting the charity hospital wherever possible, he says.

LOUISA STEYL/STUFF

The late Paul Cosgrove believed he could have been treated had his bowel cancer been detected earlier. He didn’t want anyone else having trouble getting a colonoscopy. [This video was originally published in January 2021]

The hospital was founded in response to patients who struggle to access colonoscopies. While he hopes that won’t be his primary focus in the future, he acknowledges that there will always be unmet needs as there have always been people in the community who cannot afford health care. private health.

“The healthcare system will always be limited.”

The topic of colonoscopy access came up repeatedly during Fleming’s time with DHB, leading to a series of internal and independent reviews beginning in 2017 and a public board apology in October 2020.

The reviews found that delays and strict colonoscopy waiting list criteria were hurting patients because their bowel cancer was diagnosed too late.

Fleming says he lost sleep over these stories of patient harm and adverse events — not just in terms of colonoscopy services.

He was also worried about the ‘urological disaster’ – when a review found that at least 10 prostate cancer patients had had their lives cut short while waiting seven months for urgent surgery.

Former Southern District Health Board chief executive Chris Fleming was answering questions at a town hall meeting in 2019 as the DHB prepared to transition from the leadership of Commissioner Kathy Grant to an elected board.

John Hawkins / Stuff

Former Southern District Health Board chief executive Chris Fleming was answering questions at a town hall meeting in 2019 as the DHB prepared to transition from the leadership of Commissioner Kathy Grant to an elected board.

Earlier this year the council was told that more than 3,000 patients were late for eye care appointments, and the long oncology waiting lists that were described as ‘criminal’ last year have been further delayed by Covid-19 and staff shortages.

But there’s a sad irony that those “darkest days” also produced his proudest moments, he says, in the sense that he’s proud of the improvements in those departments.

“Each of these issues has been resolved. Where we flipped a rock, we were very open to the public about it,” says Fleming.

But he warns: “We can’t be complacent, it doesn’t take a lot of population change to change again.”

Health New Zealand will need to continue to invest and increase service capacity if it is to keep up with the rapid population growth in the district.

Fleming says it will be important for Southlanders to hold the new health authorities to account, to continue to engage and to continue to push for what they need – as many creative ideas are coming from the region.

There needs to be a lasting solution to help people access primary care “in this part of the country”, he says, because the model of overworked GPs in small communities is not safe.

He doesn’t think the average Kiwi understands the importance of an ongoing relationship with a GP, not only for preventative care but also for advice on navigating the healthcare system.

And New Zealand needs to do more to develop the nursing workforce.

“It is obvious that we did not do enough 5 to 10 years ago. We can’t blame that on Covid.

But if there was ever a moment of change, it was with strong Pasifika and Māori wāhine at the helm of the health system, says Fleming, referring to Health New Zealand’s acting chief executive, Margie Apa, and to the Acting Chief Executive of the Māori Health Authority, Riana Manuel.

The health reforms gave Fleming an opportunity to pause and consider what he wanted to do with the next 10 to 15 years of his working life.

Running a regional health facility was not a priority, so when his son suggested they look for a business to run as a family, he was on board.

They will operate two Paper Plus stores 100km apart in the Waikato – where the family is from – and Fleming says this will give him the opportunity to give his son a head start.

When he joined Crown Health Enterprises as an accountant in the early 1990s, it was to avoid the regional transfer suggested by his former employer.

He stayed in the industry because of the type of people who worked in healthcare and because it constantly challenged him to find solutions, he says.

“I realized that no matter what I had done, there was still more to do. It got me hooked.”

Fleming isn’t convinced he’ll quit health care altogether.

He has already been offered consulting opportunities, particularly in the elderly care sector – as he ultimately has three decades of experience.

New Zealand’s 20 district health boards have been disbanded as part of a major health overhaul.

On Friday they merged into a single entity known as Health New Zealand, while a Maori health authority will work alongside the new agency to achieve health equity.

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