We have continued our attention to what is happening within the CDHB and with those who are writing analysing things as well. Here’s a few:
Comments this week:
This week the old Board continued in business and the new “interim” executive team started in earnest. Slowly but surely the wheels will fall off and the DHB will revert to the old ways of doing business if we allow this to happen.
The Press wrote an editorial on the dreadful relationship between the CDHB and MOH https://www.stuff.co.nz/national/health/122667355/a-healthy-relationship-that-turned-toxic. This summarised the complete breakdown of the relationship in a concise manner.
Ian Powell continues to write excellent observations, as one would expect of somebody who knows the Heath system inside out. Here is what he commented about the Editorial:
The Stuff editorial is on the button in its analysis of the toxic environment. But it gets itself into a tangle when discussing next steps. It points to the report of the Heather Simpson review of the health and disability system and then singles out its recommendation to drastic reduce the number of district health boards. After noting that 19 out of the 20 DHBs had deficits in the previous financial year, it gives the recommendation implicit support by declaring that it is “…clear that an overhaul is required.”
This conclusion ignores key facts. Deficits are driven by the failure of health spending for over a decade to keep up with the increasing costs of growing health needs. One of the main cost drivers of deficits is acute patient demand increasing at a higher rate than the rate of population growth. This is expensive. It is due to factors such as the aging of the population (including increased frailty) and increased poverty-related illnesses.
Ironically, CDHB has been the most successful of the other 18 DHBs with deficits in responding to this cost driver because of its innovative clinically developed and led health pathways between community and hospital. CDHB managed to bend the curve of rising acute demand thereby saving millions of dollars.
Here’s Ian’s complete article https://otaihangasecondopinion.wordpress.com/2020/09/07/correct-media-analysis-followed-by-incorrect-conclusion/.
It’s time to consider replacing the Board, Health Minister Hipkins:
A couple of us met with Duncan Webb this week. We expressed our despondency about the public silence of the local Labour representatives.
We suggested a list of names, from Canterbury, who could be considered to replace the existing Board, which we feel must be removed. We are concerned that the Board should not be replaced by one commissioner, i.e. somebody acceptable to the Ministry of Health, but instead should be a number of people who can bring the local community with them. It was pleasing to note how worried Duncan is. Why the Party machine shuts up good local reps is beyond me. We will be calling again on Duncan to see how he got on with our suggested list of people for a replacement Board.
The former members of the CDHB executive team start making public comments:
Sooner, or later, it had to happen. Members of the Senior Leadership Team at CDHB have finally started to talk about their experience publicly. In an amazing article by David Williams ,https://www.newsroom.co.nz/why-we-left-ex-dhb-bosses-speak-out, two of the team, Ex-chief financial officer Justine White, and colleague Carolyn Gullery, the former planning funding and decision support executive director, let their experiences out for all the world to see. It isn’t a pretty story.
White says previous boards would listen, work with the leadership team, and try to understand the background. The attitude of the Hansen-led board, guided by Levy, is to say it understands but remain steadfast in its stated outcome, she says.
“If you’re asking for the impossible, which is to strip more than $90 million out without dropping any services and without dropping any staff, you’re kidding
Just remember that the $90m figure was set by the MOH staff member, apparently guided by Levy, who has left NZ and gone back to the UK.
Then these comments from Gullery:
Gullery says her resignation was about integrity. “It was getting to the point where we were stuck between an unreasonable request and our clinical teams.”
The issue for me is that Lester Levy has an unrealistic view of the CDHB’s finances. Here is an extract from CDHB leaked Minutes:
Levy said the DHB’s operating model was too costly, and staff suggested $145 million deficit wouldn’t be “anywhere near acceptable”. “With all due respect, he did not view the plan as a credible one and did not believe the underlying plan had sufficient mechanics to actually show that it could be done,” the minutes state. He also accused staff of providing critical papers too late and with insufficient detail.
Now, I will put it on record that I am getting fed up with being told by people, including MP’s, about what I will generously refer to as the “Wellington line”. Stories about “reports being inadequately detailed” and “CDHB undertaking tasks for which they are not funded”. These comments sound so MOH-ish it makes we wonder if any of those mindlessly chanting it have asked for proof of these accusations. The best way to undermine a person, or organisation, is to make these sorts of nebulous, difficult to answer, accusations.
It was fascinating to read in this story about one cost centre which could fall into the area of “working outside funded approval”.
Efficiencies are possible, Gullery says, but Canterbury DHB already compares well to the rest of the country for operating efficiency. It has already saved millions of dollars by bringing food and laundry services in-house. “We’re left with a very small edge that we can change, and we’ve been doing that over a number of years anyway.”
Some items on the cost-savings list are services Canterbury doesn’t technically need to provide, Gullery says, “but they contribute to our ability to keep people out of the hospital”.
Home-based support will be constrained, Gullery says, as will be the acute demand service – “that’s what keeps 32,000 people out of hospital each year”.
“We didn’t propose cutting it because that would be completely futile, because we’d just end up with those people in hospital. But we did put in a plan to constrain its expenditure.”
Surely, then, a natural consequence of the cost-savings drive is hospitalisation rates at Canterbury – among the best in the country – will rise?
“That’s absolutely the risk,” White says. “Some of the services that we have on that plan, on that list, are services that are there because that’s the value they add.”
That’s also why balancing the books needs to be phased, Gullery says. “Because to get the kind of numbers they’re talking about, then we’d have to cut that stuff entirely – we couldn’t do it.”
This seems to be to be the difference between a cost accountant and public entrepreneur’s views. The cost accountant focuses on the approved expenditure, the public entrepreneur focuses on what gives a better final outcome. The MOH, and Treasury, seem to be dripping in what Oscar Wilde would say as “knowing the price of everything, and the value of nothing”.
The article by David Williams above is a must read. It is one of the best summaries of CDHB finances I have read because it is quoting the people who were actually part of the team under siege.
The issue of population funding errors isn’t just at CDHB:
If you think we are in this on our own, then think again. Below is an article about one of the South Auckland DHB’s. The issue at Counties Manukau DHB, home to Middlemore Hospital, is that they may have missed out on $300 million in funding over the last decade. The reason? The Census numbers being wrong. The same as CDHB. The difference between this DHB and CDHB is they are in Auckland. Politicians are obsessed about this City and the issue will be addressed. Here’s the article
At last the Labour MP’s say something in public:
This week Megan Woods and Duncan Webb, appeared out of the shadows to comment about the CDHB and announced…
a new car park building????!!! WTF
An analysis of Health funding:
Wisdom in The Health Service…
Wisdom says that when you discover that you are riding a dead horse, the best strategy is to dismount. In the Health Service, however, a whole range of far more advanced strategies are often employed, such as:
1. Change riders.
2. Buy a stronger whip.
3. Do nothing: “This is the way we have always ridden dead horses”.
4. Visit other jurisdictions to see how they ride dead horses.
5. Perform a productivity study to see if lighter riders improve the dead horse’s performance.
6. Hire a contractor to ride the dead horse.
7. Harness several dead horses together in an attempt to increase the speed.
8. Provide additional funding and/or training to increase the dead horse’s performance.
9. Appoint a committee to study the horse and assess how dead it actually is.
10. Re-classify the dead horse as “living-impaired”.
11. Develop a Strategic Plan for the management of dead horses.
12. Rewrite the expected performance requirements for all horses.
13. Modify existing technical standards to include dead horses.
14. Declare that, as the dead horse does not have to be fed, it is less costly, carries lower overheads, and therefore contributes substantially more to the bottom line than many other horses.
15. Class the absence of life in the horse as a “Permissible Noncompliance”.
16. Promote the dead horse to a supervisory or management position.