So Dunedin has been placated, neurosurgery stays in the region (albeit in a ‘learning capacity’). Meanwhile the flip flopping on pediatric oncology in Wellington continues. The inevitable closing of both has been delayed for a little while longer.
This is a symptom of the same issue we talked about with provincial hospitals in Health Cheque. It is not a result of cost-cutting as some fear, it is an issue of the best way of delivering a 21st century health service.
Hospital treatments are getting increasingly specialized in terms of the skills and equipment involved. Health professionals are also waking up to the benefits of working in larger teams, where people can check the quality of each others work and benefit from each others experience. Less experienced members of the team can also learn the skills they will need to lead other teams in the future. This is why no young doctors and nurses want to work in provincial hospitals or other subscale units. As a result provincial hospitals resort to locums shipped in from outside, gouging the system with high wages.
All this means that to be effective, hospitals need to be larger. In order to stay efficient, this means that those hospitals need to serve more patients. This trend is inexorable, and will continue. We are already sending patients to Australia for treatments that we are too small to be able to provide as a country. Why then, is there such an outcry over traveling to another city within our own country?
The trouble is that people see their local hospital (and all the services it currently provides) as a proxy for their healthcare delivery. Unfortunately this is a poor measure for the quality of healthcare in your area. Yes, traveling for treatment is not ideal and we should aim to minimise it as much as possible. But surely if your child has cancer you want the best treatment possible? New Zealanders need to know that in the long term we won’t get this from wards that are struggling to stay open. Smaller wards simply have fewer checks and balances, and less opportunity to share specialist knowledge. Over 1,500 people die every year as a result of hospital treatments and around 1,000 of these are easily preventable.
Otago may have got around this issue by setting up a ‘virtual team’ with Canterbury. Whether this compromise succeeds remains to be seen but there are reasons to be skeptical in a system that is characterized by poor systems: little performance measurement and non existent IT. Similar approaches could be used to prop up provincial hospitals, although to keep them viable we may need to start sending city patients to the country for minor procedures. Either way, someone will end up whining about travel.
Meanwhile this charade is diverting attention and resources from what New Zealanders should see as the real measure of their healthcare system: primary and preventative healthcare. There are many more things we could do as a country to keep people out of hospital, but the amount of money we spend on hospitals prevents that investment. We all want treatment when we need it, but it is four times more cost effective and better for your health to invest in preventative measures so you avoid needing the treatment at all. All treatments have risks, a fact that most people don’t fully understand.
We need to find a way to sensibly resolve these hospital conversations so that we can build a health system which focuses on keeping people healthy. Clinicians need to lead this conversation. One way to achieve this is to promise no staff cuts and give them an incentive to lead the change by allowing them to reinvest a proportion of any savings from restructuring in their own units. So if clinicians agreed to merge units, they could benefit from more funding to serve their patients, allowing them to improve the quantity or quality of procedures