Editorial: Drastic remedies for a sick DHB

01:43, Jan 31 2009

Capital and Coast District Health Board chief executive Margot Mains has been quick in the past to condemn critics who described her organisation as lurching from crisis to crisis. Her silence when first asked for comment in the wake of the damning Telarc audit of the board speaks volumes, The Dominion Post writes.

The audit underlines that the organisation is bordering on dysfunctional. It records grave failings, such as leaving patient records in public corridors where anybody passing can take a peek, and the already well publicised crisis in the anaesthetics department.

More recently, the paediatric cancer services have collapsed into complete disarray as key specialists have resigned without being replaced. The problems are serious, but are ones a competent senior management team should be able to solve.

However, Capital and Coast does not have a senior management team that can be relied on to solve them. The audit talks of a team that "has become stretched in too many directions for the level of experience and expertise within this team and crisis management has become the normal operating environment".

Its plan for introducing changes "lacks a clear vision and strategies to engage staff" and "management appear to have failed to gain staff confidence". There is no robust hospital-wide system to tackle staff shortages, and "each department seems to wage its own battle to fill vacancies". There are problems with patient records, the response to the anaesthetics crisis was "very slow" - the list of failings goes on.

It is hard to avoid the conclusion that the board is, as Association of Salaried Medical Specialists executive director Ian Powell said, "like a headless chicken running around looking for its head".

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It is foolish to pretend that health management is easy, as ever more complex - and expensive - treatments become available and are sought by patients, and the international competition for the services of medical staff nurses and highly trained specialists grows.

However, it is equally foolish to pretend that Capital and Coast has been well or even adequately managed. There have been too many stumbles, too many crises.

What is needed now is strong leadership. It is fortunate that Ms Mains is leaving. It was on her watch that the failures noted in the audit occurred. A new chief executive with better skills can begin rebuilding the relationships between management and the staff who actually deliver the services.

The obligation is on the board to ensure that happens. They are not immune from criticism over what has gone on so far.

While board members have limited power in a system that leaves the purse strings with central government, they should be ensuring that the chief executive is performing. It this case, they have clearly failed.

Nor is the Government blameless. New Health Minister David Cunliffe was talking tough yesterday, refusing to rule out the appointment of a commissioner to take over from the board, and saying the Government expected comprehensive and immediate improvements.

The audit was prepared months ago. It is unacceptable the Government is acting only now.

The Dominion Post