David Meates left on Saturday on an assignment in the UK working as Specialist Health Advisor. The UK is going through some very interesting changes now with England creating 42 Integrated Care Systems (ICS) which remarkably look like District Health Boards. The intent of these ICS is to create a way of working between Primary Care, Social Services, NGO providers and hospitals that is based on collaboration and working jointly together to improve the outcomes for patients and their communities.
This almost completely reflects what had been created over the past decade in Canterbury under the leadership of David Meates and his Executive Team. The UK have worked out that true integration of care services needs to happen at a local basis to ensure the buy-in and implantation of those that work locally. Central command and control systems have been again shown NOT to work.
The Welsh Health system also appears to be modelling itself on the “evidential basis” that was the Canterbury Health system. David will be working with this team.
It never ceases to amaze me that international health systems seemed to understand what was being delivered in Canterbury and just how unique it was to have all parts of the health system in Canterbury working together for a common purpose – to support the community / whanau / individuals to lead the best live possible in a way that “aimed not to waste their time”.
Isn’t it depressing that some of the very best leadership talent in this country, formerly working for CDHB, are now helping to shape health systems in other parts of the world? Because they know what works.
What’s even sadder is that the previous Exec at the CDHB have again been given a “complete” clean bill of health from Audit NZ the DHB’s External Auditors – again achieving some of the best ratings across all DHB’s and public entities:
- The Management Control Environment were rated by Audit NZ as “good”
- The Financial information systems and controls were rated by Audit NZ as “good”
- The Performance Information and associated systems and controls were rated by Audit NZ as “very good”.
Normally organisations would be celebrating this type of audit report. I am led to believe that there was some push-back by some at the CDHB Board table against these reports.
It also reinforces my cynicism of large accounting firms that EY stated the following after they had been engaged by the Board:
“Finally, we have acknowledged throughout the project, and in our discussions with management, that Canterbury DHB has been highly successful across a range of domains including access to care, quality of care and building an effective integrated health system. We have also acknowledged that the DHB has faced many significant challenges over the past decade including natural disasters, unexpected tragedies (the March 2019 Mosque shootings), delays in the migration to Hagley and more recently the COVID-19 pandemic. Our scope of work did not include any assessment of how successfully the DHB has managed these challenges, or the impact they have had on its operational performance.” 19thAugust 2020.
Ian Powell eloquently articulated that the function of EY was “to do a hatchet job”. Well, EY, Audit NZ did it for you.
External review after external review undertaken on CDHB over the past decade have ALL shown that CDHB has remained one of the best functioning and cost-effective health system in NZ. It is bizarre that a few individuals have continued to be driven by their own distorted believe systems NOT THE FACTS. And still the current DHB Chair and Crown Monitor bag the old system.
It does not bode well for the new health reforms in NZ. Give it time and the NZ Health system will be looking to the UK for advice as to how to re-build integrated systems!