With the CDHB financial year finishing on 30 June 2021, we at the Tuesday Club are waiting with breath-holding-anticipation to see how the DHB actually performed against budget.
As previously covered, the Board / Crown monitor reluctantly supported the proposed budget put forward by the then Executive of the DHB. This was against a background of the Crown Monitor / MOH believing that a much lower deficit could be delivered.
I well remember the Chairs comments to the Health Select Committee in March 2020…
Addressing a Parliamentary health select committee on Thursday, CDHB chair Sir John Hansen said he did not believe the spate of resignations last year had been detrimental to the board’s finances or services.
“In actual fact there might be savings because we brought in acting chief executives with the experience we felt were needed … but the other roles were filled by the people … who have stepped up. So, I don’t think there will be a financial impact.”
It is worth remembering that the previous Executive had over the past decade delivered on its fiscal and service plans every year, as agreed by the Board. At the same time this former executive had addressed some of the impacts of NZs largest disasters. These included multiple earthquakes, floods, fires, terror attacks and Whakaari / White Island. These events also led to massive demand for mental health services within the population. This executive had delivered some of New Zealand’s largest health facilities while constantly dealing with the other disaster. Called the MOH.
We are waiting with much anticipation for the financial results!!
There is another report that we are also waiting with much expectation. This is the Audit NZ Report for 2019/20. I fail to understand why this report has not been made public.
Over the past decade of its audits Canterbury was either the highest rated DHB or in the top quartile of DHBs. Given that no other DHB (or other organisation outside Canterbury) had gone through a decade of natural disasters beginning with earthquakes, this was an impressive performance.
CDHB was rated ‘Good’ for both ‘Management control environment’ and ‘Financial information systems and controls’ for each of the 2016-17, 2017-18 and 2018-19 financial years. For ‘Performance information and associated systems and controls’ CDHB was rated ‘Very Good’ for each of these same years.
As Ian Powell highlighted in his overview of the CDHB (A Very Bureaucratic Coup:Part Two):
“If Audit NZ’s 2019-20 audit of CDHB finances is consistent with previous years, then surely those who have been blackening the reputations of the previous senior management team (and continue to do so) will need to reconsider their positions and the Government reassess their appropriateness to continue in their roles. If Audit NZ doesn’t bow to Levy’s pressure (there is no reason to believe that it will) then his credibility is in tatters.”
We are waiting with much anticipation the Audit NZ Report for 30 June 2020!!
What is a PIN Notice?
Staffing levels and the lack of response from the DHB is creating an environment where there are now genuine concerns being expressed that patient harm will occur because of understaffed and stressed services. Understaffing has got so bad that on 29th July the Christchurch Hospital Emergency Department issued a Provisional Improvement Notice (PIN) notice to the DHB.https://1news.co.nz/one-news/new-zealand/fed-up-christchurch-ed-nurses-issue-notice-their-bosses.
This is a written notice to the employer asking them to address health and safety concerns in the workplace.
A PIN is issued by employees only when staff concerns continue to NOT be heard / acknowledged and addressed. This gives an insight as to just how bad the disconnect between the Board / Executive has with their workforce.
When was a PIN last issued at CDHB?
It is distressing to hear, with increased frequency, concerns that there will be both patients and staff harmed because of the ongoing chronic and severe understaffing. Too often people are now referencing back to the late 1990’s / early 2000’s when things got so bad that the Stent Review was undertaken based on concerns that patients were being harmed. That was a bad part of the Canterbury DHBs history.
We would also like to know what has happened with the EY review which the Board had prepared. This stated that there were at least 200 too many nurses in Christchurch Hospital and that the same nursing workforce could deliver 60,000 more bed days of care!! Has the current executive, which is acceptable to the MOH and Treasury and the Board, responded to the accuracy of this document? Or was it just wrong?
There is an acuity tool mandated (Trendcare) by the government to measure the acuity of patients and the required level of nursing care that should be provided. I believe that it is showing that almost every inpatient area at Christchurch Hospital; and mental health services at Hillmorton are below the required levels for safe and appropriate care.
It is the chronic understaffing that is behind the ongoing industrial unrest with nursing and the fact that underlying staffing issues are not getting resolved.
Recent increased demand on services has put pressure on several areas. Staff I have spoken with are using words like “toxic” when they describe the atmosphere at CDHB in a number of areas. Apparently, this has been reflected in a recently completed staff survey undertaken at the CDHB. When will the Board release the results of this survey?
Feedback from general practice is also highlighting an increased disconnect with the DHB. The engagement with general practice had been part of the how the CDHB managed massive demands over the past decade. It would be a travesty if this continues to deteriorate.
The problem for Canterbury is that for the past decade it managed an unprecedented decade of natural disasters, extreme capacity constraints and massive increases in demand. It did so with a highly engaged workforce, and connected health system that TRUSTED their leadership.