Rutherford project frustrating

We haven't got the money so we've got to think. That was the premise under which The Rutherford project was set up in the Marlborough and Nelson government health sector. PENNY WARDLE investigates what kind of thinking they have been doing.

Community health providers under scrutiny by the Nelson Marlborough District Health Board say it is impossible to plan ahead, with a review aimed at making $10 million of savings in three years taking longer than expected.

A ring around of service providers to the board revealed uncertainty as to whether contracts would be renewed, reluctance to fill vacated positions and fear about job losses.

The Rutherford Initiative, rolled out in May 2009, was named for a quote from Ernest Rutherford: "We haven't got the money so we've got to think."

Hospital, community and corporate services to the board are being investigated to achieve savings of $10m in three years.

Board chief medical adviser Andre Nel told The Marlborough Express that the Rutherford review could result in provider contracts being re-negotiated, aligned to remove duplication or cancelled.

"This is not a group of people coming into a service and telling them what will happen," he said. "We have worked together in a sensitive way towards adding value."

Communication had been through portfolio managers, Dr Nel said.

However, the majority of providers spoken to by The Marlborough Express felt they had been excluded from the process. All were informed when the review began but there had been little or no communication since.

The Rutherford Initiative worked in each area then submitted a report including recommendations to chief executive John Peters, Dr Nel said.

Mr Peters would work with the general manager of each area to agree on actions which could require negotiation with staff.

"Change management may involve discussion with unions," Dr Nel said.

Lakewood Resthome and Hospital manager, Julie (who preferred not to use her last name) said the board could be doing a better job of keeping providers in touch with how the Rutherford Initiative was progressing.

"Even flicking the odd email to say `we haven't forgotten you' but haven't got around to your area yet," would be helpful.

Julie put her hand up to help the Rutherford team look at aged care. The offer was accepted but the only communication since an orientation meeting last August had been a reply to an email sent to the board in November, requesting an update. She was asked whether she would be available in January and February so expects to hear back soon.

Julie said people couldn't complain about change if they hadn't involved themselves with the process. "But you can complain if you have been excluded."

The interim manager of Te Rapuora, Graeme Grennell, said the Rutherford review started well for the Maori health provider. However, nothing had been heard since.

"We are hoping to have some input before the report comes out," he said.

The review had made planning difficult, for example a drug and alcohol counsellor's position was left empty for nearly six months as Te Rapuora waited for the review outcome but was eventually filled.

"Late last year staff were getting quite agitated about it," Mr Grennell said.

Information was filtered through a Maori managers forum representing Marlborough's three Maori providers, who met with the DHB each month. However, the subject hadn't come up for some time.

Care Marlborough support manager Birte Flatt said her organisation had been updated on the Rutherford review through mental health advisory forum, Te Roopu Tupu Tahi and portfolio manager Lorraine Eade.

Community providers in Marlborough included Kimi Hauora Wairau (Marlborough PHO Trust), the Supporting Families in Mental Wellbeing, Asthma Marlborough, Diabetes Marlborough, Care Marlborough, the Schizophrenia Fellowship Marlborough and St Marks Society. Thirty two doctors, 11 pharmacies, five resthomes, 10 dentists, three Maori health providers and three home-based support providers also provide health services to the board.

Providers would start hearing formally from the board in February, Dr Nel said. Meanwhile, portfolio managers should be approached about any concerns.

GPs would not at this stage be included in the review unless there was an issue with a contract, Dr Nel said.

So where is the project now?

The Nelson Marlborough District Health Board was five months off finishing its Rutherford Initiative.

Four reports had been completed looking into information technology, payroll, business support and director of nursing, Dr Nel said.

About 16 more reports would be submitted to chief executive John Peters by the end of June, recommending ways that efficiency could be improved.

"The project is about doing things smarter," Dr Nel said.

The Rutherford team anticipates that its recommendations in the payroll area could save $124,000 and that $1.13m could be pared from information technology, between 2009 and 2012.

The team found the payroll office had been "plagued with complaints and issues" due to high turnover of managers and staff, a review summary said.

In the last year this had improved due to the appointment of a new manager and changed responsibility for payroll as well as improved tracking, training and performance monitoring.

The Rutherford team looked at the pros and cons of combining payroll functions with five other DHBs in the region. These thoughts were pre-empted by the Government's establishment of a National Health Board which was working towards consolidating functions like payroll and information technology throughout New Zealand.

"Typically, nationalising of back-office functions is fraught with problems and takes some time to complete," the Rutherford team's summary said.

"Given the divergence in payroll systems between the DHBs and the plethora and complexity of employment agreements nationwide we suspect that the ministry's initiative will take some time to implement."

Changes were being made along the way, Dr Nel said. In the information technology area 200 PCs were being progressively replaced as staff were issued with smartcards which allowed them to work on any computer in a hospital without logging in and out, for example. Plugging cellphones into computers and making phonecalls via the internet rather than telephone cable, would save money at Support Works in Marlborough.

A project office manager who left last year would not be replaced.

In the payroll area, recommendations included introducing electronic inputting of timesheets and leave applications to reduce manual handling and errors.

Board staff were now paid fortnightly, some one week and others the next, Dr Nel said. Paying all salaries in the same week would involve less overtime for payroll staff, the review suggested.

- The Marlborough Express