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Statement on the Sustainable Health Services Report
Message from C&C DHB Chair Judith Aitken
The Dominion Post today claimed, quite wrongly, that C&C DHB had produced a ‘secret report which recommends cutting the number of Doctors’.
There is and never has been any secret whatsoever about the Sustainable Health Services report. Its production has been widely publicised at public meetings of the Board, at community and business meetings, amongst our own medical staff, and within the medical unions.
The report was commissioned by the Board in June this year. The need for it was driven by the persistent and chronic financial deficits experienced by the Board and its ever-worsening difficulty in finding the money to fund essential medical , nursing and related services.
The purpose of the exercise was to assemble a reliable fact base about where we were financially, what the financial drivers were, the impact of these on the viability of our services, and the scope – if any – for managing these risks internally in a realistic and sustainable way.
The report that was accepted by the Board this week contains no recommendations. It makes it clear that there are real problems with the quality of data and the scope of the financial analysis.
It suggests where, from a purely analytical perspective and against some recognized NZ benchmarks, there may be scope for redirecting staff and other resources.
At no stage did the Board seek or accept any recommendations about reducing staff numbers, especially the numbers of doctors employed in our hospitals.
No decisions were sought or made by the Board on any change in the levels or configuration of any current services.
Consideration of any such changes is a long way down the track.
C&C DHB is still in the early stages of an important analytical process that began in June, and has engaged the attention and review of clinical staff, team leaders and service managers at various levels. Their useful experience-based comments were all factored in to the draft Report.
The SHS review document has this week gone to the Minister for his consideration.
In June, the Board decided it was critical that the Government had a report that began to set out the chronic financial situation the Board has faced for a number of years, and the need for sound reviews of the drivers of those difficulties.
The Government, the Board and the whole community are well aware of the reliance placed on the continued commitment of all our clinical staff and the extent to which their professional work is the basis for our long term sustainability.
Additional Information
Doctors Numbers
In terms of doctor numbers, the SHS report uses one particular index - Case Weighted Discharges per medical FTE - to analyse current staffing provision.
On that single – and controversial – index, and in theoretical terms, C&C DHB may have more FTE doctors than other DHBs and the average productivity of those doctors appears to be lower. However, the report also notes that the comparisons it makes in terms of doctor FTE numbers are to be treated with great caution, as the figures are not absolute and do not recognise factors such as the increasing complexity of patients’ conditions, and the impact of increasing use of outpatient services.
These analytical shortcomings were all noted by the Board.
The report signals the need to look closely at past and current forecasting and planning of services and the way they are configured, work which has already started in relation to transition to the NRH.
The terms of reference for the SHS project were:
to review the basic financial structure of CCDHB and evaluate its viability over the medium term in light of such factors as:
- the population based capacity of our secondary and tertiary services
- anticipated increases in productivity associated with migration to the new regional hospital and stabilisation of new patient-centric models of care
- likely capital and revenue capacity
- likely demand scenarios in relation to hospital-based services
- likely supply and quality of clinical skills
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