Issues for Auckland and Public Health System in NZ
Outline
Issues for Auckland and the Public Health System in NZ in 2005 and beyond
David Galler
Principal Medical Advisor
Ministry of Health
Principal Medical Advisor Role
• Arose out of the need for a broadening of the advice to the Minister of Health
• Half time secondment to MoH
• Independent advisor to the Minister and Director General
Our Health Sector
• A tumultuous recent history
• Divided and fragmented – multiple agendas
• Endless change – an atmosphere of mistrust
STAFF DISENGAGEMENT
Our Health Sector
• Clinical staff have lost the ability to effectively influence the direction of the inevitable change that takes place around us.
• Despite more alignment between the underpinning principles of our health system and the ethos and values of health professionals and the public, ie public funding and universal access, clinicians remained turned off.
The NZ Health Strategy is in line with other social democracies and faces similar challenges
• Epidemiological- the double disease burden
• Demographic – aging, young Maori PI population, geography.
• Funding
• Workforce
• Consumer and clinician expectation
We are moving towards a more population-based ecological model of disease.
One which recognises the importance of the wider social and economic determinants of health.
Health Policy
Hence:
• The investment in prevention and in primary care.
• A team approach to population health utilising all the skills that are available
DHBs, PHOs and the HPCA Act
with its “Scopes of Practice”.
Health Policy
Much of this change is seen in the context of our experience in the 1990s
If these policies are to be successful the context in which these changes are cast must be better explained and more generally accepted. They will never deliver the desired outcomes without the buy in clinical staff.
Key issues for the future of the our public hospitals that require input from clinical staff
• Value for money
• Staff engagement
• Workforce and training
• Service configuration – a key area of concern for Auckland and NZ
Funding
• Government concerns about the affordability of future demands.
• Rising cost pressures from disease, aging population, drugs, technology, salaries, consumer expectations
• Relatively small GDP.
• 20c of every $ to health.
We need to look at new ways
of doing things.
VFM: Economy, efficiency, outcome
We focus on managing the costs of the $4bn invested in our public hospitals but we do not manage the business
• Are our resources being wisely and effectively spent?
• Do we have agreement as to what our priorities are and what we are getting for our investment?
• Clinical input is essential
Costs are outstripping revenue
Staff Engagement
• Despite the Minister’s Letter of Intent in 2003/4, this is still a relatively new concept that is yet to be embraced by many in management
• As the fiscal pressures rise the accountant/managers look for short term fiscal solutions
For our part, many of us don’t want to know that more is expected of us
• Mastery of knowledge
• Unilateral decision process
• Autonomy and self management
• Individual responsibility and accountability
• Detachment
• Reflective practice
• Interdependent decision process includes patients and colleagues
• Supported practice - team work
• Collective responsibility
and accountability
• Engagement
Undergrad Training
New grad doctors and nurses are not trained to do the job we need them to do
• Why do our young doctors need to retrain via a zillion courses?
CRISP/CRIMP/EMST/APLS/BLS/ATLS
• Why do our new graduate nurses need expensive mentoring programmes?
Postgrad Medical Training
• Not matched to the demand for quantity and quality of Doctors
• Post grad training now controlled by a series of extraneous interests:
Colleges – increasing sub specialisation
RDA - Service/training issues/contractual
CTA – Lack of a clear strategy
A radical reappraisal of how we organise and provide our services is required
We need new Models of Care both within and between our institutions
Only possible through co-operation and collaboration at a regional level on a service by service basis led by clinical networks.
“Just send me the patient”
vs.
“The virtual regional service”
There are advantages for all parties:
Improved clinical safety across the region
• Financial gains
• Improved training
• Greater diversity of work experience
• Better collegiality
• Multidisciplinary approaches
• New ways of working - telemedicine
There are lessons to be learned from the success of the Auckland Hospital Trauma Service
• Real leadership
• Clinical excellence
• Coordinated patient centred care
• Multidisciplinary care
• Reliable consistent service
• Established lines of good communication
• Outcome driven
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Ministry of Health
