Comparing Health Policies 4 – DHBs

There is an interesting difference in emphasis in the policies on hospital services. Labour’s is again very broad-stroked with no costing and emphasizes ”A Strong and Safe Public Health System You Can Trust“. National’s is very focused on waiting lists and Hospice, although it does discuss other aspects of DHBs. The preambles of both documents are eerily similar, with Labour criticising the health reforms of the 1990s and National lambasting the decline in productivity in hospital services on Labour’s watch. Labour’s policy opens with:

“Labour will ensure a coordinated hospital and specialist health care system of consistent quality across the country.”

Precious little detail here apart from some talk about a Quality Improvement Committee. It has probably escaped their notice that the profusion of bureaucracy that has invaded hospital services has almost entirely been driven by “Quality Improvement” initiatives. These initiatives do nothing except switch the emphasis away from patient care and onto documenting process. So when National say they will

“Reduce bureaucracy in health and shift savings to frontline care.”

That has some resonance with most frontline staff. In contrast to Labour, who think that better high-level DHB communication will help improve services, National’s emphasis is on promoting ”clinical leadership to improve services”. As a long-time advocate of proper clinical leadership, I confess to bias here. I have NEVER seen a management-initiated solution work in the health industry, and I have been a doctor for 27 years. Good solutions in health are always built from the clinical frontline, upwards. Endless meetings and committees just serve to slow things up, rather than facilitate change.

Verdict: Impossible to say as there is nothing concrete suggested. I prefer a clinical leadership approach but will try to be unbiased and call it a draw. 

“Labour will continue to build and upgrade health facilities to ensure we have top quality infrastructure.”

National has no stated policy for this, though I can’t see that they would object to capital expenditure on hospitals. Note that, although Labour talks about “new” hospitals, these are, of course, replacements for old buildings. These new hospitals also tend to be considerably smaller, often exacerbating bed shortages.

Verdict: As Labour is the only one with a policy here, we will give this one to them.

“Labour will target reduced waiting times for elective surgery in priority areas, such as cardiac, cancer and orthopaedic services.”

And that’s about the sum total of Labour’s plans to reduce waiting times. There are no details and, of course, no dollar figures. Unbelievable. 

National’s plan consists of:

• Invest in 20 new dedicated elective surgery theatres to provide better, sooner, more convenient access to elective surgery in the future. 
• Train more surgeons, anaesthetists, and nurses to support the new theatres – estimated at an additional 800 health staff.  
• Make smarter use of private hospitals and primary care to support public hospital elective surgery and reduce waiting times. 

These points are in addition to promoting clinical leadership and reducing bureaucracy, both of which will help towards streamlining waiting lists. The first two points are also properly costed. I have already commented in another post that building another 20 theatres will require extra ancillary staff such as lab techs, Radiographers, ICU beds and nurses, Physios and the like. I suspect that National’s dollar figures are thus rather on the low side of the actual cost.

Verdict: Despite National’s suspect costings, they have policy and Labour has talk. No contest. A clear winner for National.

“Labour will invest in information technology so that the flow of health information between primary, secondary and tertiary health sectors is achieved in a timely and seamless manner that also safeguards patients’ privacy.”

After nine years of persisting with woefully inadequate IT, suddenly Labour has seen the light. Yeah, right. At least National had an excuse. In the 1990s, IT was considerably pricier and harder to customize. Touchscreen technology and graphical interfaces were in their infancy. The IT patched together for hospital use was about the best they could do. 

Verdict: National does not have a specific policy, but Labour’s is so vague – and they have such a long history of ignoring IT –  that it is virtually worthless. No winner declared here.

“Labour will build stronger regional clinical and administrative networks, with shared integrated services that efficiently use resources and avoid duplication.”

Both Labour and National have been promising to integrate services since I emigrated to New Zealand in 1995. I’m still waiting. Health services are just as fragmented as they were then, particularly between DHBs. A recent HDC report highlights this. National say they will:

• Encourage clinical networks across regions to assist in the planning, delivery and improvement of care. These networks will involve clinicians, non-government organisations, GPs, and patients.
• Expect DHBs to adopt new and innovative ways to improve timeliness and care.
• Hold the chairs of DHBs accountable for improvements in productivity and quality within their organisations. 

National suggest looking at Flinders Medical Centre’s (Adelaide, South Australia) “Lean Thinking” project which has produced 20% productivity gains while actually enhancing staff morale. Making the DHB chair accountable for productivity would be welcome. More attention would be paid to exactly what DHBs are paying for.

Verdict: Both parties have a dubious track record. National at least has some constructive thoughts on the matter. National wins by a nose.

“Labour will strengthen the provision of ambulance services by instituting a staged plan to deal with funding, workforce, crewing, and training issues.”

National has no (published) ambulance policy. Technically, neither has Labour, as it is still in the consultation document stage. That the ambulance (and helicopter) services are in dire need of help is obvious to all in the health services. 

Verdict: Hard to say again. I’ll give the nod to Labour for at least mentioning the ambulance services

“Labour will focus on developing sustainable and high quality palliative care services.”

My, aren’t they doing a lot of “focussing”? Some dollar figures are attached, but they are all about previous funding, so I assume they are saying that no extra funding is needed. There is no detail on how palliative care will be improved.

National, on the other hand, have a comprehensive policy on hospice care. As they point out, hospices still receive only about 50% of their funding from government. The rest is from donations. This leaves them very vulnerable in times of economic distress.

“National will boost funding for hospices by $15 million a year to expand care and services and meet current financial challenges. This investment will provide equitable funding across hospices and secure this vital health service for our communities.”

This increase will boost hospice funding to 70% of expenditure. Note that palliative care consists of more than hospice care alone. DHBs provide palliative care beds and clinics as well. These are also underfunded, but not nearly as badly as Hospice.

Verdict: Do I need to say National?

Overall Verdict: Again, a more all-encompassing policy by Labour – seriously marred by the fact that it is chiefly waffle. National again targeted to the hot spots. Kudos to Labour for at least mentioning ambulance services, but another barely-fought win for National.

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