Editorial: Health reform

OPINION: The wind of change is blowing through the health sector in the South Island.

This was apparent at the recent Health System Showcase 09, organised by the Canterbury District Health Board, from which emerged the need to think innovatively and work collaboratively across all levels of the sector to ensure that the region has a sustainable healthcare system. What is also apparent is that health clinicians must play a leading role in this process.

Already the benefits of this approach, which should be a model for other district health boards, are being felt. Sixty-four GPs have been trained by plastic surgeons to remove lesions at their own practices. For patients this means that their treatment is cheaper and faster than being referred to a specialist, which could mean many months before receiving the necessary operation.

A greater focus on care in the community and on people taking greater responsibility for their own health helps break down the traditional division between primary and secondary healthcare. It also reduces pressure on hospitals, which is essential if the health system is to meet the challenge of an ageing population.

Those over 65 years old now comprise 14 per cent of the region's population but account for almost 50 per cent of the health budget. With the number in this age group increasing, by 2020 another hospital the size of Christchurch Hospital would be needed, as well as substantial increases in the number of aged residential beds and general practices.

The Government has indicated that the large health-budget increases of the past will not continue, meaning that the prospect of such a public hospital being funded in Christchurch is impossible, especially given the plans to revitalise the current one.

On the West Coast, the local district health board has a different problem – it has a small population spread over a large area and an ageing Grey Base Hospital. There it has been suggested that the board focus less on the bricks and mortar of hospitals and more on local community trusts providing integrated primary healthcare.

The reason that clinicians must be to the fore in reforms is that they are at the cutting edge of the health sector. They, rather than politicians and district or national health bureaucrats, are best placed to identify ways in which services can be streamlined and improved.

This is in line with the Government's aim to focus resources towards frontline services and away from the sizeable bureaucracy.

Greater involvement of clinicians and other senior staff in planning has been occurring. An example of this was the decision by senior clinicians to take a leading role in driving through improvements to the Emergency Department at Christchurch Hospital.

Clinical leadership could, one health expert has suggested, save up to $60 million in Canterbury. Initiatives could include giving clinical leaders incentives to reduce pharmaceutical prescribing, reducing inappropriate referral and admission rates and providing more appropriate community-based services.

These are the sort of initiatives which, led by senior medical staff, are essential if the people of Canterbury are to receive the quality of health services which they expect from their district health board.

- © Fairfax NZ News