A record 145,414 patients received elective surgery in the year ended July 2011 says Health Minister Tony Ryall.

Elective surgery operations include hip and other joint operations, cataracts and grommets amongst other important life improving surgeries.

“This means an extraordinary extra 27,000 patients a year are now benefiting from elective surgery compared with the numbers treated under the previous Government”, Mr Ryall says.

“Over the term of this Government, around 60,000 more elective operations have been delivered over the three years.

This would be a good achievement if it occurred during a time when the Government had massive surpluses and could throw unlimited dollars into Vote Health.

To manage to get an extra 27,000 elective operations a year during a time of our largest ever fiscal deficit, and a global recession is quite extraordinary.

The tone of this conference here in Wellington will no doubt stand in stark contrast to that of the Irish public sector union only a few months ago.

In what has been described as a firebrand speech, the union chief demanded his members accept a four year strike ban, a pay freeze following pay cuts, massive redundancies and rationalisations – all of which were agreed with the Irish government earlier in the year.

What is more remarkable is the acceptance by his members and others in the public sector that the global financial crisis and its impact on the Celtic Tiger required such austerity….that is acceptance from the unions other than the secondary teachers union.

After undertaking months of industrial action including marching in the streets, that secondary teachers union there last week decided to finally accept the facts of recession and is joining the wider public sector pay restraint.

Wonderful swipe at the PPTA by implication there. How long is it going to take the PPTA to realise they are not getting free laptop for every teacher?

And then Tony continues:

The United Kingdom is facing the largest peacetime deficit in their history. Public servants earning more than $40,000 are facing a two year wage freeze, and performance-related pay for civil servants will be cut by 2/3rds.

Just last week the Governor of the Bank of England urged unions to accept public sector reforms and job cuts by warning that anything short of tackling the UK’s Budget deficit would “fail the next generation.”

In Italy the Government passed an austerity package of around $50 billion of saving which includes a freeze on public sector wages.

In Ireland the Government has cut public service salaries – including doctors, nurses, and teachers – by up to 15%.

Greece‘s socialist government has frozen public sector wages and pensions for the next three years.

In Hungary they plan to cut the cost of public servants pay by 15% and freeze government spending.

The Portugese government has put a hiring freeze on its civil service, along with a 5% wage cut for top earners in the public sector.

Germany has the strongest economy in Europe.  But the Germans plan  to reduce the number of their federal public servants by 15,000 – or 5% – and cut their salaries by 2.5%.

Canada has frozen wages in the public service for the next two to three years.

Compared to what’s happened internationally, New Zealand’s response has been fair, moderate and pragmatic.

And then Tony goes on to praise the PSA:

I would like to acknowledge the Public Service Association for the constructive and responsible part you have played in employment negotiations to date. You are professional yet determined.

You have sought settlements for your members that recognise the tough financial times we are all in.

While hard fought, those settlements have been responsible, realistic and fair to both parties…often between one and two percent. You’ve also been innovative in your approach to addressing productivity improvement.

Which is another message to the PPTA they are not getting 4%.

TV3 reports:

Health Minister Tony Ryall has been forced to admit he has been making secret visits to emergency wards, gathering intelligence.

In breach of the usual ministerial protocol, Mr Ryall has not warned staff he’s on the way, nor has he introduced himself when he has arrived.

“If I’m in a city or a town and I’ve got a spare five or 10 minutes, sometimes I drop by the emergency department to sit quietly and see what’s going on for a few minutes,” Mr Ryall says.

“Maybe talk to some patients, see what’s going on and how long they’ve been waiting. It helps me to keep in touch.”

Superb. A Minister asking patients about the service and waiting times. As Tony says – an excellent way to keep in touch with the real world.

Emergency departments contacted by 3 News didn’t know about Mr Ryall’s visits and had varying views on the practice.

One head of emergency welcomed the undercover Minister, but others thought it was “perplexing”, “insulting and undermining” as well as “creepy and weird”.

Some have questioned his method, labelling it an “unscientific way to gain an impression of an emergency department”.

“Conditions change by the hour, there are protocols for visiting Ministers.”

Yes how dare the Minister gain an unofficial impression. He should only gain the impression that is arranged for him carefully beforehand.

I don’t think Tony is going to make major policy decisions on the basis of his visits.  But it is a good way to see at first hand what it is really like for patients.

“I’ve never known a Minister of Health not to abide by protocols working with the clinicians and the management of a hospital,” says Labour’s Associate Health Minister Annette King.

Oh dear. Need more be said.

About 250 Wellington patients will have their operations in private hospitals after district health boards decided they could not meet Health Ministry elective surgery targets without help.

Hutt District Health Board is negotiating with Boulcott Hospital to perform about 50 mostly ear, nose and throat operations, while Capital & Coast District Health Board has asked private hospitals to carry out 200 cataract operations.

Hutt chief executive Michael Hundleby said the board turned to Boulcott Hospital because it was concerned that Wellington Hospital – which does 40 per cent of Hutt DHB’s surgery – did not have the capacity to complete the operations.

Some on the left will cry out that this is privatisation. I suppose they would rather those patients simply remain on the waiting list rather than have the private sector provide the operation. Who cares about quality of life so long as we are ideologically pure eh.

Health Minister Tony Ryall said he was not concerned that DHBs were using the private sector to help them meet the health targets, which were introduced last year.

“Our priority is that patients are treated and in the Wellington region we’ve had a record total of 11,232 patients getting the elective surgery they need.”

Great.

The Government has delivered a record increase in the number of people who received elective surgery.

Last year, 134,763 patients got elective surgery funded by district health boards, which is in excess of 12,000 more than the number treated in 2008.

That’s a 10% increase, which is a hell of a lot.

The performance far exceeds National’s goal, which was an increase of 4000 a year.

Some of the biggest increases were at Waikato DHB (17 per cent), and in the Auckland region, where the Auckland DHB achieved 12 per cent and Counties Manukau 13 per cent. …

And the proportion of elective surgery the DHB contracts to the private sector remained stable last year at about 12 per cent.

This could be a lesson that there is a big difference between spending and effective spending.  Tony Ryall is obviously managing the latter.

State Services Minister Tony Ryall yesterday gave an update on the Government’s “cap of core government administration”.

The number of full-time jobs in core administrative roles fell by 1480 or 3.8 per cent last year to 37,379.

At the same time, said Mr Ryall, 540 full-time equivalent jobs had been added in “key frontline agencies outside the cap”, including Child, Youth and Family, Work and Income, and Community Probation.

“National campaigned to cap the size of the core bureaucracy and we’ve done that. This allows us to free up resources for improving frontline services,” Mr Ryall said.

After a 50% increase in the size of the public service under Labour, this is a great achievement.

It is so popular than even Phil Goff was trying to have it both ways. On TV last night he was claiming that Labour would also have capped public sector numbers – just not reduced them. Yeah, Right.

“We would have looked at the quality and the need for the staff, it would have been more about capping and not cutting,” says Labour leader Phil Goff.

I wonder what Grant Robertson thought of his leader’s endorsement of National’s policy of capping the number of staff. Maybe Grant could clarify what Labour’s policy now is? I am sure the PSA have been on the phone to him.

At the last election National campaigned on capping core public service jobs, a policy PSA national secretary Brenda Pilott said was “a farce”.

So is Brenda saying Phil Goff is supporting a farce?

“The Government has been cutting, not capping, jobs at a time when unemployment rose to a 10-year high.”

And the Government is borrowing $240 million a week. Private sector jobs create income for the Government, while public sector ones soak up that money. The fewer jobs we have in the private sector, the fewer we can afford in the public sector. This is why economic growth is rather important.

Tony Ryall with Simon Bridges making the announcement in front of the DHB Chair. Tony enthused about being Minister of Health, declaring it is the best portfolio you can have in Government – a sentiment not shared by too many of his predecessors!

See that sign in the background of Simon, being interviewed by the local BOP Times reporter? Yes it does say “We love you Simon”. The (as it happens all female) staff of the pathology lab put the sign up when they realised the announcement was outdoors. Simon didn’t even see it until a reporter pointed it out to him. He of course them popped inside to thank the staff for their sign! I don’t think Simon has to worry about his majority!

And if you wonder how Tony Ryall manages to get such good press – it is because he only allows National MPs to interview him!

Actually it is not as bad as it looks. The camera man was reading out the questions from the reporter (whose voice will no doubt be dubbed in later), but they needed Simon to hold the mike and stand where the reporter normally would, so Tony looks in the right direction.

Apart from my amateur photography, just been enjoying the beach and shops up here. The weather is lovely!

First we have Tony Ryall from last week’s General Debate on Labour’s seven stages of grieving.

And then by popular demand an embedded version of Gerry Brownlee yesterday.

After the 1990s National Administration taught the sector that business-minded managers were in charge, terms like “clinical leadership” and “trusting nurses and doctors” have resonance. Mr Ryall’s speeches are rich with them, reflecting his leg-work in Opposition and the evolution of moves started by Labour. He has instructed health boards to give clinicians more decision-making power.

Overseas he found that “clinical networks” – doctors hooking up across boundaries – make health services more effective. Enhancing the prestige of health workers may also counteract the pull of higher salaries overseas, helping to solve the health workforce crisis without massive pay rises.

There are some risks with greater power for clinicians, but there was little doubt the managerial culture had gone overboard, and the secto was drowning in bureaucracy.

Surely this dream run can’t last for a man in a portfolio which traditionally involves nasty public scraps over strikes, treatment delays from under-funded hospitals, or deaths due to medical mistakes.

Perhaps he will be dragged into a messy pay dispute. Health boards are lining up for what Waitemata DHB has told Mr Ryall will be staff-cost growth “based on a zero per cent increase on all employment agreements expiring during 2009/10″.

The pressures will only get worse.

He has incurred the ire of public health practitioners over cut-backs to anti-obesity funding, but these are in line with National’s philosophy that what we eat and how much we exercise are matters of personal choice and not socially nor environmentally determined.

And National is still funding many public health programmes. What Tony stopped funding was lobby groups to lobby the very Government that funds them.

Tony should also be looking at the funding of Te Reo Marama, as detailed by Whale Oil. They’ve had $1.2 million since 2004 and most of what they do seems to be attend overseas conferences and write letters to the editor.

It is not that long ago – only a matter of months – that the loss of 500 jobs in a crucial branch of the state sector would have been the major news story of the day. …

The same could not be said about this week’s announcement that the axe will fall on close to 500 positions in the Ministry of Health and across the country’s 21 district health boards over the next 18 months.

The media reaction was very ho-hum despite the layoffs actually being closer to 700 once 200 vacant positions in the Ministry of Health which will not be filled were included in the tally. …

Increasingly, the feeling is that the public has – to borrow from Helen Clark – moved on from the days when it could get outraged by the merest hint of slash-and-burn spending cuts or privatisation. The assumption was that National won last year’s election through John Key positioning his party more to the centre. It is clear now that a large portion of the electorate had already shifted to the right.

John is partly right here, but only partly. The public mood has shifted, but I would not call it a shift to the right. It is the same shift we have seen in the UK, where most of the public now support spending cuts.

It is not a change in political views, but a reaction to the recession. Part of it is a feeling of shared belt-tightening. If businesses and households can tighten their belts, so can the Government. And it is partly that people do understand huge deficits and massive borrowing is not sustainable.

The other aspect I would point out is that it is hard to call what Ryall is doing as slash and burn spending cuts. He has promised that Vote Health will not decrease, but the gains from the bureaucracy reduction will be transferred into frontline services. This changes things considerably.

Getting widespread support in favour, rather than against, what you are doing is harder but here is reaction yesterday:

NZMA:

The New Zealand Medical Association (NZMA) today welcomed the announcement by the Government of substantial changes to the health system.

“It makes great sense to rationalise the backroom services of the District Health Boards (DHBs) and to provide much greater coordination of national services and we support the decision to place the National Health Board within the Ministry of Health,” said NZMA Chair Dr Peter Foley.

NZNO:

The New Zealand Nurses Organisation (NZNO) supports announcements made today by the Minister of Health, Hon Tony Ryall, which will see greater collaboration in health across New Zealand’s 21 District Health Boards (DHBs).

“We are pleased that the Government and the Minister have taken heed of the submissions made in response to the Ministerial Review Group report ‘Meeting the Challenge’. We welcome any additional resources to workers at the front line of the health service,” said NZNO President Nano Tunnicliff.

“The changes signalled are a sensible continuation towards a more nationally integrated health service,” Tunnicliff said.

ASMS:

“We are chuffed that the government has listened to advice from us and others on the health proposed by the Ministerial Review Group (Horn Report),” said Mr Ian Powell, Executive Director of the Association of Salaried Medical Specialists, today.

“The Horn Report recommended creating a new bureaucracy, the National Health Board, as a separate, less accountable crown entity, in addition to the Ministry of Health. This would have involved major restructuring, and risked increasing bureaucratic wastage and generating paralysis in decision-making. We supported the functions proposed for the National Health Board but not the recommended structure.”

“We have worked hard lobbying government not to go down this path. Instead we recommended that the functions be allocated to a specific enhanced unit within the Ministry of Health. This is exactly what Health Minister has announced today and we are delighted. It is a relatively novel experience of a government listening to us in such a specific way.

And even the Health Cuts Hurt lobby group:

“Health Cuts Hurt supports the principles behind the Government’s decisions about the public health system announced today but is concerned that the devil is in the so far undelivered detail,”

“How can you oppose more consolidation of the administrative functions like purchasing in bulk and more regional cooperation in service delivery along with returning savings from these things into more operations or hospital beds,” said Heather Carter.

Oh I am sure Labour can, if they try hard enough

HFANZ:

Efficiency gains expected as a result of changes to the public health system announced by the Government today have been welcomed by the Health Funds Association (HFANZ).

Tony Ryall really is doing well with what is traditionally a very dangerous portfolio. If only, the same could be said across the entire Government!

“Cabinet has agreed to a number of proposals from the Ministerial Review Group’s report ‘Meeting the Challenge’ that will greatly improve national and regional cooperation and reduce duplication of back office functions, ” the Minister said.

As a package, the changes will move up to an estimated $700 million in savings over five years to frontline services. That would buy about 16,000 heart bypass operations or build two large city hospitals.  The changes are also expected to reduce the health system bureaucracy by up to 500 administration jobs. These would be managed as much as possible through attrition and voluntary redundancy. …

The major changes include setting up a new National Health Board (NHB) within the Ministry of Health. The NHB will focus on supervising the $9.7 billion of public health funding the 21 DHBs spend on hospitals and primary health care.

The new NHB will manage national planning and funding of all IT, workforce planning and capital investment. It will also take national responsibility for vulnerable health services such as paediatric oncology.

Work will also start on consolidating the 21 DHBs’ back office administrative functions such as payroll and bill payments.

“Officials estimate a one-off cost of between $5 and $10 million to set up the changes and that will be met within the Vote Health budget. Up to an estimated $700 million is expected to be saved in the first five years from coordinating procurement and logistics. All savings will be reinvested back into frontline health services.”

I don’t think anyone can object to the intention of these changes. If they save even a fraction of what the official cite, that will be a good thing freeing up money for frontline services.

The challenge for the Government is to have them go smoothly. INCIS is a prime example of good intentions going astray.

But I’m pleased the Government is prepared to take the risk, in order to make improvements. The status quo is not good enough.

Acting Prime Minister Tony Ryall celebrated his temporary promotion today with one of his infamous fashion ensembles — a black and white striped shirt with a clashing pink tie daubed with multi-coloured spots.

Can’t Kara do something about these?

Mr Ryall formally took over the reins of the country this afternoon when Deputy Prime Minister Bill English left for Australia to join three other colleagues more senior than Mr Ryall.

It is believed the first time someone ranked as low as five in cabinet has made it to the position of acting prime minister.

Unfortunate they all had to be in Australia to attend the rugby very very important trans-Tasman Ministerial Council meetings.

Mr Ryall will be tailed by diplomatic protection squad officers until Saturday evening, when Mr English returns to New Zealand.

Hmmn if Tony was shot, who would be Acting Prime Minister? It would be Nick Smith. Nick could do with DPS protection to handle the unruly locals in Nelson.

They will have to accompany him to a fund-raising event in his Bay of Plenty electorate, which he gleefully told party members was being hosted by the acting prime minister.

Mr Ryall has joked that, from next week, he would like to be referred to as the former acting prime minister.

That would mean more if Winston didn’t have the same title

• Longer stays for new mothers in birthing facilities
• An optional meeting each trimester for at risk mothers, attended by the pregnant woman, their GP, and their lead maternity carer (usually a midwife)
• Obstetric training or refreshers for GPs wishing to return to maternity care
• Fully funding the Plunketline 24 hour telephone advice service

I think the second point may be the most important. The changes made in the late 1980s by then Health Minister Helen Clark have been a disaster for many parents. GPs have abandoned maternity services, and doctors and midwives have often been silos – not talking to each other.

And far far too many babies have died needlessly, because of a lack of competence amongst some (not all) midwives. A refusal to call in a specialist has proven fatal too often.

So the three monthly meetings between mother, GP and leader carer is a commendable initiative.

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.

1. cut emergency department waiting times so 95% treated within six hours
2. deliver faster treatment for cancer patients – all those needing radiation treatment to get it within six weeks by July 2010 and within four weeks by Dec 2010
3. carry out more elective surgery – an extra 4,000 operations per year
4. more immunisations – 85% immunised by July 2010, 90% July 2011 and 95% July 2012
5. better help fro smokers to quit – 95% of smokers in hospital to be given advice and help to quit
6. better diabetes services

What were the targets from the previous Government:

1. 13 health priorities
2. 61 objectives
3. additional subset of 13 health objectives
4. 10 health targets measured through 18 indicators
5. 25 other indicators of DHB performance
6. 4 hospital benchmark indicators assessed through 15 measures
7. an outcomes framework with 9 outcomes, measured against 39 headline indicators

Sounds like doctors may have more time to see patients and be spending less time reporting on priorities, objectives, indicators and outcomes. Also sounds like we may have a few less administrators.

This afternoon Mr Ryall announced he has removed Richard Thomson from the position of appointed Chair of the Otago District Health Board.

“During Mr Thomson’s chairmanship, the largest fraud in New Zealand State Services history was taking place at Otago DHB. $17 million was defrauded over 6 years,” said Mr Ryall. …

Mr Ryall also announced that Mr Errol Millar, an appointed member of the Otago District Health Board will take up the role of Chair immediately.

Mr Millar was appointed to the Otago DHB in 2007, having been appointed to the Southland DHB in 2002 and 2004. He was also Chair of the Airways Corporation 2001-2004, and is currently Deputy Chair of the Civil Aviation Authority. …

Mr Thomson remains an elected member of the Otago District Health Board.

This isn’t about blame or responsibility for the fraud – but accountability.

As I blogged a few weeks ago, the Board does have some accountability for this. Their goverance was sub-standard in my opinion. They should have had policies around competitive tenders etc.

The Government has found itself in the embarrassing position of jointly financing a $165,000 conference on drug policy with one of the world’s leading advocates of decriminalising marijuana use.

Not sure this is an issue, as the funding does not appear to give any input into the agenda or speakers.

Billionaire currency speculator George Soros’ Open Society Institute has given $35,000 to this week’s symposium, which will be attended by Government ministers, police and a judge and will examine New Zealand’s drug laws.

Mr Soros is known for financing drug reform campaigns, and most recently backed a referendum in the American state of Massachusetts which decriminalised possession of small amounts of marijuana.

Soros needs something to do, now Bush is no longer in office. He spent almost NZ$50 million in 2004 trying to stop Busg get re-elected.

The Ministry of Health confirmed its funding of the symposium last week. This was after Mr Ryall told the ministry to review its involvement with all conferences, and leaned on it to cancel a conference of more than 300 health professionals that would have cost $123,000.

The spokeswoman said Mr Ryall – who was listed on a draft agenda to open the symposium – found out about the ministry’s sponsorship only late last week. She said it would now be opened by associate health minister Peter Dunne, who would be telling those attending “the Government absolutely does not support the decriminalisation of cannabis, and is committed to a strong enforcement of that law”.

Certain Government Departments seem to be having trouble understaning what a “no surprises” policy means.

Personally I think it is a good thing if a drug policy conference debates, ummm well drug policy. But there is a legitimate question about whether Government Departments should fund a conference considering such issues, when the Government is not seeking to change its policy.

Labour leader Phil Goff said he would be concerned if there was “any motivation” by conference organisers to legalise marijuana, which the Labour Party opposed.

That’s an interesting statement, and a sign I think of the Goff leadership. Labour under Clark made some moves towards de-criminalisation, but then ruled it out as part of agreements with United Future. Now they are not constrained by United Future, it is fascinating Goff unilaterally declares the Labour Party position. I suspect a secret poll of the Labour Caucus would find close to half, and maybe more than half, quite open to considering decriminalisation on its merits.

I think Mr Goff should keep campaigning in defence of taxpayer funded conferences.

But more important was to move forward and the decision to transform Sir John Anderson from Commissioner to Board Chair, and reappoint the Board Members who were elected in 2007. This means it is not just going back to the past, but using the skills also of Sir John and his team.