Herald backs health targets
The NZ Herald editorial favours the new health targets:
Targets can be the bane of any organisation. Unless they are well defined and readily measurable they are worse than useless, create more work than necessary and waste time and money that could be used for something more useful. The Minister of Health, Tony Ryall, has found some classics among the previous Government’s targets for district health boards (DHBs), which he has culled from 10 to six.
Worse than that:
As he put it, “We have inherited a system overburdened with 13 health priorities; 61 objectives, with an additional subset of 13 health objectives; a set of 10 health targets measured through 18 indicators; 25 other indicators of DHB performance; not to mention four hospital benchmark indicators assessed through 15 measures; and an outcomes framework with nine outcomes measured against 39 headline indicators”.
And think of all the administrators needed both at DHB level, but also at the MOH to measure and report on all these.
When Labour scrapped the previous National Government’s business model for hospitals and related services, replacing Crown health enterprises with district health boards, it made much of the democratic element of elected boards. But in fact the boards were set up as branch offices of the Health Ministry, which decided most of what they would do.
Having elected members on DHBs, actually dilutes accountability as it allows the Minister to blame the local DHB and vice-versa.
This Government is content to keep Labour’s administrative structure and the best it can do is try to simplify its procedures. Impractical, largely symbolic declarations on nutrition, obesity and physical activity have gone. As Mr Ryall said, how could a district health board be held responsible for increasing the number of people who ate the recommended daily portions of fruit and vegetables?
The six goals he has set look sharper: shorter stays in emergency departments (95 per cent of patients to be admitted, discharged or transferred within six hours), faster elective surgery (an increase of 4000 a year), shorter waits for cancer treatment (radiation within six weeks by August next year, and four weeks by December).
Those three are treatment targets, the rest are preventive: immunisation for 85 per cent of 2-year-olds by July next year, rising to 95 per cent two years later; help for hospitalised smokers to stop; more people to be assessed for risk of heart disease and more free checks for people with diabetes.
Inevitably, there will be complaints that worthy causes have been ignored. Already the Obesity Action Coalition asks where responsibility for nutrition, physical activity and obesity lies if not with health boards. Well, many could answer that one. It lies with the individual.
You can’t trust individuals – once you start doing that, society will crumble.
May 18th, 2009 at 6:29 am
As was confirmed not that long ago, there are now more administrators/managers/analysts in health (all on very healthy salaries) than we have hospital beds.
This is why under Labour, even though we spent approximately 3.5Bil a year more on hospitals the waiting list doubled.
It was an incredibly expensive mistake for New Zealand to vote in Labour, and then we compounded the problem by voting them in twice more.
May 18th, 2009 at 8:09 am
Putting on my tin hat, I would love to see a zero based recalculation along the following lines:
(1) How many doctors, nurses, radiographers, therapists, cooks, orderlies, cleaners, launderers and other front line carers are needed to deliver the level of service required by the community?
(2) Assuming one manager at the top, what is the minimum possible number of necessary administrators, technical specialists and accountants necessary to positively support (in the sense of being on the same side, with the same objectives) these front line carers.
No PR, HR, lawyers, or media specialists need apply.
Similar considerations should apply to universities.
May 18th, 2009 at 10:15 am
“You can’t trust individuals – once you start doing that, society will crumble.”
Chances that someone will misquote this ironic statement at some future date: 100%
Validity of statement as a summary of socialist mindset: 100%
May 18th, 2009 at 1:30 pm
This is all very well – I just hope that these 6 goals do not simply shift resources away from other areas, in order to satisfy the 6 KPIs at the expense of patients suffering from conditions that are not Ryall’s flavour of the month.
I agree with the general view that Labour’s plethora of touchy-feely goals created a socialist’s paradise of middle-management paper-shufflers all creating work for each other, instead of fixing sick people. This was the unanimous view of 2 relatives who work in clinical roles in NZ public hospitals…
(Not that I was any more of a fan of Shipley’s “Please take a number and have your credit card ready” model, where hospitals were “Crown Health Enterprises” not hospitals, and patients were “clients” or “end product users” not patients, and the general level of bureaucracy was the same, only it was reams of corporate BS not reams of socialist BS that the black suit brigade inflicted upon those who were actually trying to heal the sick…)
May 18th, 2009 at 2:16 pm
“I just hope that these 6 goals do not simply shift resources away from other areas, in order to satisfy the 6 KPIs at the expense of patients suffering from conditions that are not Ryall’s flavour of the month”
I could see that happening under Labour, but with Nationals drive to reduce waste and cut fat there should be some slack in the rope that can be taken up.
May 18th, 2009 at 9:29 pm
Tony Ryall – isn’t he the same chap who is bringing in 6 hour targets to emergency departments?
The “gaming” has already begun! Our ED is having beds “redesignated” as “adult assessment” beds – this means patients
are moved a few metres along the corridor from ED and “hey presto” they are no longer there!. Of course, they are still being looked after by the same ED docs and nurses…. This experiment was a dismal failure in the UK and is being cheered on by certain ex-NHS CEO’s here in Godzone. If there was a God he would know why.
Lung cancer “targets” will soon mean that surgeons radiologists and pathologists will have to treat lung cancer patients as a priority over any other clinical need. Lung cancer is the new breast cancer perhaps? Little import is given to the almost complete lack of benefit in treating lung cancer over the last 40 years.