It's easy to get the impression the Taranaki District Health Board is rolling in cash. It is well into an $80 million building project and has an operational budget of $320m.
But the financial reality is it faces a daily battle to balance its books.
Like households around the province, the TDHB has to keep costs that are increasing within a budget that isn't, all the while improving the level of service it provides to Taranaki.
TDHB chief executive Tony Foulkes says while this year is going to be tough in many respects, it will be exciting, with the move to the new facility beginning in August.
"Overall, 2013 from my point of view will be a year of major change in how and where we provide services for the people of Taranaki and the reality is that, as well as that, we have to be able to continue to step up a gear in terms of our financial performance."
One area where the finances are adding up is Project Maunga, the new hospital building. It is on track to come in on time and on budget. Services will start to move into the new building in August although it will not be finished until the end of the year. The old building will then be demolished. There will be a four-storey link between the new construction, through what is now the in-patient block, to connect with the rest of the hospital.
As well as improving the look of the place - there will be a proper entranceway - the project will bring improved patient services. All rooms will have an ensuite, providing comfort and dignity for patients, as well as decreasing the chance of falls and helping control infection. Now about 12 patients use each bathroom.
Patient safety will be improved and there will be better facilities for disability and rehabilitation services as well as an enhanced information technology environment and better equipment.
"It's a step up overall, a wonderful development for staff and all people in Taranaki," Foulkes says. "One of the big areas in the development is we'll have six brand new, pretty much state- of-the-art operating theatres, which is close on a 50 per cent increase from what we've had previously. And we will be able to provide more and better day-stay services."
The facilities now aren't set up to cater for procedures that can be provided to patients who can then be safely discharged home the same day. The new facility will have space for more beds, he says.
"So when we first move in we expect to be using the same number of beds. We have capacity to increase in the future."
Therefore, there won't be an immediate need for more staff.
Sometimes there is difficulty recruiting for specialist positions, he says, which is true for all health providers.
The board works with Venture Taranaki and the local councils to attract people to the region and has scholarships to attract young people to the sector.
"We've found once people learn about Taranaki DHB as an organisation and Taranaki as a province people are keen to stick around." The TDHB collaborates with other health boards if it doesn't have people with the necessary skills, to access skills such as visiting specialists.
The TDHB has a good record of financial performance overall, Foulkes says.
"However, within that our hospital services currently do cost more to provide than the allocation of funding . . . that's a real challenge.
"We're confident with the team we've got in Taranaki who work together with the board, we'll meet the challenges and continue to provide great services for people in Taranaki in the future."
One of his biggest fears for the future is around the status quo, because he believes the board can do better than it is now.
"And secondly, we can't afford the status quo as it is now. So we need to look at doing things differently . . . It's about us concentrating on getting the best we can for the resources we have available and being flexible enough to be able to challenge ourselves about how we have traditionally done things."
Talk to any of the TDHB members and they say the same thing. It's about doing more with less.
Chairwoman Mary Bourke says the issue is the area where the costs continue to rise but the amount of funding to deliver certain services remains the same - the hospital arm of the DHB.
"That's why that's the area that is constantly running a deficit. We do technically break even most years, but the expectation is that we'll do better than that."
Funding is population based and if the province's population is not growing at the same rate as other regions, Taranaki doesn't get the same increases in funding.
And Taranaki's population is ageing, meaning more people are likely to need healthcare.
Foulkes says while doing more for less sounds like an impossible conundrum, it can be done by looking at how the board can make the best use of its resources.
This means looking at how some services, once provided at the hospital, can now be obtained at primary care level.
"If people can safely be cared for in the community then we need to be able to ensure the right support exists. There is no one single answer, a whole range of approaches need to be taken.
"We need to make sure clinicians in the hospital and in the community caring for the same patient have access to all information in a timely fashion and at the moment we don't do that as well as we could. Things like that are going to be really important for the future."
Another aspect is making sure people's skills are used well. An example, without increasing the number of staff, is looking at how nurses can have greater interaction with patients and be better able to use their skills rather than doing other tasks such as paperwork, he says.
Pharmacists in the community could use their skills to help people with long-term conditions and to support doctors in the care of patients in the community. "That's an important resource that is already there."
The TDHB is looking at developing intermediate care for people who have had an extended stay in hospital and need rehab care.
"This care can be provided in a different setting prior to them going home. It will be initially set up in New Plymouth.
"We hope it can be extended throughout the province. In part, it will be for older people who may need a longer period of support."
The people of Taranaki can be confident services received here compare with the rest of the country - Taranaki compares extremely well with other DHBs of similar size, he says.
"That's not to say we're perfect, there is always room to improve, but we compare favourably."
One area where the Taranaki DHB could do better is in radiology services. It is the worst performing in the Midlands area. In the case of community-referred CT scans, Taranaki is only reaching 40 per cent, well short of the 75 per cent target.
"I think access to diagnostic services and the timeliness of that is really important and it will increase in importance. We want to look at the total system not just the hospital services. It is an important area and we will work with Fulford [Radiology Services] and with the PHO to be able to improve in the future."
Another area marked for improvement is in assisting people to give up smoking. On a Ministry of Health list of targets, Taranaki is on the bottom of the country's DHBs.
"We're doing a lot better than we were doing before. It's not just the hospital but in the community. It's a really important area and, yes, we could do better," he says.
Board member Pauline Lockett says the targets are set by the ministry but the board makes sure there are the necessary resources to meet the targets.
"I think that becomes quite a critical factor - looking at that and making sure, from an operational perspective, we have the capabilities to achieve strategic outcomes."
One of the issues with health across the Western world, is there is a higher expectation from the public around health needs and that's driven from scientific perspective, she says.
"We are able to achieve greater things with health than we were even 10 to 20 years ago. The tension then is around meeting the expectation with the cost of those expectations. There is always going to be that tension within the health arena. It's nothing new."
The Taranaki DHB covers more than just the hospitals. It includes primary care, with doctors, a whole range of non-government organisations working with health, Maori health providers and collaborating with other DHBs if necessary.
The board is made up of 11 members, of whom seven are elected by the public and four appointed by the Minister of Health. The TDHB serves a population of 104,280 people, or 2.8 per cent of the nation.
Elected board member Karen Eagles says doing more with less doesn't mean cutting services.
She has heard another DHB is looking at moving operations that provide grommets for children into private healthcare. That is not a move she would be in favour of because the operation has huge benefits for children.
"Our managers are very good at finding ways to make savings [without cutting services]. That's what they've done already, but its not easy."
In South Taranaki, Alex Ballantyne says the community forums set up last year have been going well.
There is a community steering group, chaired by mayor Ross Dunlop, and a community forum that links with a community clinical forum where clinicians from the hospital and the community are able to discuss issues together.
In the past there were community representatives on the DHB, he says.
And the board is now discussing reinstating the groups, but in a different format - something Ballantyne supports.
The Project Maunga website: tdhb.org.nz/project_maunga/ home.shtml shows the building work being done in real time.
- © Fairfax NZ News
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