Clinicians' 'need more of an insight into money'

22:37, Jun 08 2014

As part of our series on the review of surgical services at Nelson Marlborough District Health Board, Heather Simpson writes about the role of doctors in finances.

Senior doctors should have a greater understanding of finances to understand monetary limitations on their service, a surgical review says.

But Nelson Marlborough District Health Board chief executive Chris Fleming said it would not mean doctors would become accountants.

A major recommendation in the top of the south review of surgical services said the board should develop reliable mechanisms to track financial and other resource allocations. This would help the board make decisions about what services were supported and what services could be developed.

Fleming said the board received about $420 million in funding but questions arose as to how much it spent on medicine and on general surgery and mental health, and why.

The board did not have a robust model that tracked services in which there was over and lesser investment, Fleming said.


The board was considering a model in which clinicians would have a greater input in collective decision-making over finances.

The way the board allocated resources had largely been a combination of planning and history, he said.

"If we are a break-even DHB there are some services in developing this model that might been seen as more generously funded with a high level of access. By default others will be lesser funded. What do we do with that model to make sure we are able to stay in control of our destiny?"

"Do we have a clear picture making sure there is equitably invested money across the system and where we have problems or not. We don't."

Fleming said the board did not intend to go through a revolutionary shake-up that cut cash to generously funded services and re-invest the money in other services.

It wants clinicians to have more collective responsibility in financial decision-making.

This would be an evolutionary process, Fleming said.

The board did not yet know how the financial model would look but it would involve serious discussion among clinicians.

"I don't want to create a financial model that will create perverse behaviour. A natural reaction is how much we spend on Nelson, on Golden Bay and on Wairau Hospital . . .

"What I want to know is do we have safe and sound services, are we providing services as close to home as possible and is there reasonable equity of access to services?"

The Marlborough Express