Corporate Mindset Compounds Health Problems
West Coast Unemployed Rights Centre
CORPORATE MINDSET COMPOUNDS HEALTH
Op-Ed By David Tranter
A few years after the introduction of corporate management to the health sector, Public Health Coalition spokesman Dr. Alistair Scott commented, "The new consultation; listening without hearing, talking without understanding". Having been involved in rural health issues since 1991, and after a year on the West Coast board before resigning in protest at management's agendas, I believe many of the on-going problems in providing health services are attributable to the approach identified by Dr. Scott.
Like many health activists I welcomed the introduction of elected board members at the end of 2001 and was delighted when the seven elected West Coast members agreed we had to "stick together" in order to effect any change. Sadly, that resolve quickly evaporated as members caved in to the corporate agendas. The modus operandi dictated by management was shown by their disregard for a concession I obtained from the board chairman that the c.e.o. had to refer to me before putting any items on the in-committee section of the board's monthly meeting agenda. I withdrew from that arrangement after the c.e.o. had broken it four times with only myself objecting while board members failed to support me in something they themselves they had formally approved. That set the tone for all that followed.
Having established control of the board the Greymouth corporate office now take extraordinary liberties with the legal provisions supposedly justifying the discussion of agenda items in committee during monthly board meetings. One recent monthly meeting had eleven items in committee while another had nearly three-and-a-half hours in committee out of a total of under six hours meeting time. Why all this secrecy? Is this what government means by "open and accountable" health management?
Management domination and secrecy are particular problems for smaller boards like the West Coast's. The public are disregarded under a continuation of the corporate offices' pre-2001 agenda despite extravagant claims of community consultation. This is illustrated by the fate of the plan put forward about eight years ago by Reefton G.P. Buzz Burrell in which he proposed streamlining management of health services for the Reefton/Inangahua District thereby saving enough money for all patient charges to be eliminated while providing better coordinated services. Here is a real working model for the current, increasingly troubled PHO system. Dr. Burrell's scheme was highly detailed including costings and coming as it did from a very community-involved G.P. it described a health service based on the realistic needs of the community. Yet the authorities have ignored it. The Coast's PHO now has a veil of secrecy thrown over it such that even my Official Information Act request for details of reduced local G.P. charges was forwarded by the corporate office to the Ministry of Health who, of course, supplied only the theoretical national guidelines. Contrast all this with a DHB press release dated 27.9.02 in which their planning manager, Graeme Savage declared, "The PHO will be governed by the people of the West Coast.." while board vice-chair Christine Robertson stated, ". for the first time people on the West Coast will have the opportunity to shape primary care.". And pigs might fly!
What happened to these promises? Why won't they consider Buzz Burrell's plan? In my view the reasons are; (1) Management cannot admit that someone outside the corporate palace might know better about an issue; (2) Their empire is threatened by the bureaucracy cuts involved in Dr. Burrell's scheme; (3) They cannot grasp the notion of a community-based health system with minimal management but without a corporate office!
Another major problem common to DHBs is the recruitment and retention of professional staff. No-one denies the extent of this difficulty but it would certainly help if management took serious notice of why people leave. Buzz Burrell made no secret of his frustration with the local bureaucracy when he left. Around twenty G.P.s came and went through the board's Buller Medical Centre in a single year. Most recently, Westport G.P. Ken Mills has announced his departure stating that the board "are basically driving me out". (Westport News 19.12.03). Confirming his departure Dr. Mills later stated, "I can't deal with the bureaucracy. I can't deal with all the agendas". He also described the PHO as a "disaster" and that "It's a meccanno set without directions, being sorted out as they muddle along". (Westport news 19.1.04). Most infuriating of all to the public was management's dumping of long-serving surgeon, Hugh Bodle. Despite the most community protest I have ever seen about rural health issues, and despite endorsement of Mr. Bodle from health professional groups, management were adamant. When the matter came before the board the public discussion promised by the chairman was squashed by his stating during a closed session that publicly disagreeing with management constitutes breaking the law under the Health and Disability Act. When I raised for discussion the nurses' letter supporting Mr. Bodle a board member stated that nurses are not competent to comment on surgeons. That letter and the G.P.'s letter were arrogantly dismissed. The "discussion" promised for the public meeting that afternoon consisted of the chair asking board members in turn if they approved of management's action to which all except myself gave their assent. It is difficult enough to recruit health professionals but that difficulty is increased when there is so much contempt shown by those in control for the views of health professionals and the public alike.
During the decade since corporatism took over the public health system one word has frequently been said to me concerning the change in the culture of health management. It is the word "evil" - not necessarily referring to the individuals involved but to the effect of the new system. In my experience much of the wonderful spirit which used to prevail in the public health system has been lost. I saw it beginning to crumble even between my two New Zealand-wide journeys in 1992 and 1995 when I met many people associated with rural health services. Their growing despair with the new corporate bureaucracy was already painful to see.
Is the caring ethic of earlier years irretrievably lost? I hope not, but for it to be re-vitalised government must empower elected health boards to do, amongst other things, what Annette King herself told the elected board members in Wellington in December 2001 - to "dig into" your local bureaucracy. On the West Coast a dozen administrators ran health services before 1993. Now there's about a hundred of them - plus stacks of computers and outside consultants. What are they all for?
In my view they have lost the plot. Health management has become an end in itself - a power game - instead of a means to an end. The corporate monster rules. It is time the tide was turned.
Contact - David Tranter, Omoto Valley. ph. 03 7686112
NOTE David Tranter, was elected to the DHB and then resigned last year out of Total frustration with the way the DHB was run by the staff.