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Heather Roy's Diary, 3 March 2006

Heather Roy's Diary

Most people find it difficult to get excited about District Health Board Deficits - even those who think our health system is failing those in need. The deficits or surpluses however are one measure of how well a board is managing (or not) it's funding in relation to the services it provides for its local population. Other measures must be considered in conjunction with the financial status - the number of procedures and operations done, the numbers waiting for treatment and the length of time people wait are all indicators. An OECD report released last year said that it couldn't conclude how well the New Zealand Health system was doing because monitoring was poor and incomplete. The message was simple - that's a fail on reporting and a 'we have no idea' on how well the health system is operating practically. Anecdotally those who are fortunate enough to see a specialist or get into a hospital bed will generally say their care was of a very high standard. Our doctors, nurses and health professionals are doing a great job. Complaints are all around the lack of accessibility to treatment. Poor system with good people propping it up.

DHB Deficits - not sexy but still important

Statistics New Zealand released the quarterly figures last Friday for the financial status of District Health Boards. The combined total deficit position for the quarter to December 2005 was $21.8 million and this combined with the previous quarter deficit meant that the half year overspend by DHBs was $26.5 million. This figure is already well above what the government had previously signalled would be acceptable.

In 2002 then Health Minister Annette King said she was aiming at a deficit "close to zero" within three years (i.e. this financial year). By June 2005 she had changed her tune saying that she and Finance Minister Michael Cullen had "agreed to a sector deficit of $13.4 million for 2005/06". Treasury's figure however is much more realistic - the 2005 December Economic and Fiscal Update (DEFU) predicted that deficit for the whole year would be $80 million. The Auckland DHB, the board which has the largest deficit for a variety of reasons mostly not of its own making, announced this week that it was looking at a $50 million deficit. The $80 million figure is most likely to be correct because it is always in the last quarter that boards struggle to come within budget.

One reason the boards blow their budgets is because of extra costs heaped on them by government. The extra costs of the Holidays Act (hospitals can't close their doors on public holidays like cafes) and the increases to hospital nurses pay are two items that have hit hard. Asset testing for the elderly in residential care will have to be absorbed as well later this year with Labour guessing at how much extra this will cost boards. Many have already expressed their concerns that reimbursement will go only part way to covering the increased costs so yet again they will have to make savings elsewhere. The only easy place is to cut elective surgery - make non-urgent cases wait longer. District Health Boards are left between a rock and a hard place and then are expected to take the inevitable flack from irate patients.

Comment on the latest deficit figures has been enlightening.

* The Ministry of Health says "DHBs are generally managing their financial performances well'.
* Treasury says current funding tracks are unsustainable into the future.
* Health Minister Pete Hodgson has said nothing at all.

I'm with Treasury - current funding paths and expectations on DHBs are unsustainable and alternatives for funding and service provision must be looked at. A novel thought for Labour would be to look at what private health providers have to offer, but that would require the removal of their ideological blinkers.

Deaths on Waiting Lists.

Just over a year ago I released the figures of those who had died while waiting for treatment. The statistics did not tell us if the person died of the condition they were waiting for treatment for but the concerning factor was the large increase in this number - almost 40% - in a two year period. In the year to August 2002 850 people died while waiting for treatment. By August 2004 this had risen to 1,187.

The breakdown by District Health Board can be seen at dhbfigures.

Previous Health Minister Annette King lost her cool and as a result the way in which figures are now collated do not show how many people have died on waiting lists. As of 1 November 2005 the Ministry of Health has changed the codes used for capturing deaths of patients while waiting for surgery. They have reduced the number of 'exit categories' for identifying reasons why patients have been removed from the waiting list. Previously there were ten categories of which 'deceased' was one. Others included those who had gone privately, those discharged to their GP and those removed from the waiting list for medical reasons. Now there are only four:-

1. Patient received publicly funded elective treatment
2. Patient received publicly funded acute treatment
3. Patient returned to GP care
4. Patient removed due to changed patient circumstances (e.g. deceased, gone private, unfit for surgery)

The Ministry of Health said reporting has changed because "categories were found to be confusing". They worry that data might be misconstrued. I'm afraid I have to disagree - previously the statistics were very clear, now they have been deliberately confused with other categories, presumably so that an opposition health spokesman can't point out the truth of the real situation.


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