Adam is a political reporter for the New Zealand Herald.

Tragic slips rising with pressure on spending

The Government is trumpeting improvements in waiting for elective surgery, cancer treatment and for accident and emergency treatment. Photo / Thinkstock
The Government is trumpeting improvements in waiting for elective surgery, cancer treatment and for accident and emergency treatment. Photo / Thinkstock

Eileen Anderson died a lonely death in Palmerston North Hospital and although 91, she went before her time.

A chart mix-up and lack of checks meant she received the wrong medication for four days, leading to a decline in her health so rapid that she died before her family, including her daughter, could farewell her.

Mrs Anderson died 10 years ago, but the account of her death featured in a recent health sector report which recorded a 19 per cent leap last year in such "serious or sentinel events" - avoidable mishaps that led to injury, loss of function and in some cases death.

Mrs Anderson's case illustrates the kind of tragic mistakes that are increasingly common in the country's overworked hospitals, says Lesley Harry of the Nurses Organisation.

The number has been on an upward trend for years. The 377 recorded last year was 59 up on the year before, and more than double the tally five years ago.

Ms Harry fears the Government's sharpening focus on state sector savings will see greater funding pressures in the health sector, more pressure on staff and more avoidable mishaps.

The Government and senior managers are adamant savings can be offset by greater efficiency, and services can be maintained and even improved.

The Government has vowed to reduce the number of back-office staff across the state sector, including health, in order to free up resources on the "front line".

Accordingly, the head count at the Ministry of Health has fallen from 1675 in late 2008 to 1200 this year, and 665 management and administrative jobs have been cut across the 21 district health boards.

Health Minister Tony Ryall says 2000 more nurses and 800 more doctors are now in hospitals than when National came to power.

He cites improvements in reduced waiting times for elective surgery, cancer treatment and for accident and emergency treatment.

However the Nurses Organisation and the senior doctors' union, the Association of Salaried Medical Specialists, are deeply suspicious of Mr Ryall's numbers and say his targets tell only part of the story.

Ms Harry says her organisation does not know where Mr Ryall's additional nurses are, but senior nurse numbers have actually been cut.

Ian Powell of the specialists' association, which has been skirmishing with Mr Ryall over doctor numbers for months, is more blunt, calling the extra physicians "a misleading fiction". The doctors fear actual declines in clinical staff numbers.

Recently, as district health boards grapple with the prospect of tighter budgets over the next three years, reports have said Auckland, Waikato, Hawkes Bay and Bay of Plenty DHBs may cut frontline staff.

They are said to be looking for tens of millions of dollars in savings as they face the prospect of relatively small budget increases to meet growth in demand, and this year, for the first time, staff KiwiSaver costs must come from operational spending.

Director-General of Health Kevin Woods would not speak to the Herald but last week told MPs that health outcomes and service quality were improving, "albeit against the background of a tight financial situation".

"Maintaining this is the primary challenge for both the ministry and the sector.

"Whilst we are on a lower growth path for the resources available to us, investment in health continues to grow."

The health budget, which accounts for about 20 per cent of Government spending, rose to $13.95 billion in the current financial year, an increase of just under 3 per cent on the previous year.

That's a far cry from the double-digit increases under Labour before the global financial crisis.

Mr Ryall told the Herald that DHB funding will increase again this year to "record levels".

But while funding may still increase, Mr Powell fears it will not be enough to meet increased demand arising from a growing older population and from poverty-related diseases, which are rising.

The system has been under additional pressure from the Government's increased expectations on what the sector should deliver on, including Mr Ryall's election promise to reduce elective-surgery waiting times from six months to four over the next two years.

While Mr Powell says timely elective surgery - which can prevent more serious and costly future problems - is a good thing, he believes the focus on particular targets is driven by the political desire to demonstrate increased productivity.

The things that can be counted are only about a third of what hospitals do, he said.

Public Service Association national secretary Richard Wagstaff says his union has concerns that the funding pressure on DHBs will affect not just the services they provide directly, but also those they purchase from others, such as home care.

"The way they're going to save that money is by reassessing people's needs."

That would inevitably hit the disabled and aged, Mr Wagstaff said.

Eighteen months ago, Ken Whelan quit the chief executive position at the heavily indebted Capital and Coast District Health Board in Wellington, citing continual financial pressures which could no longer be offset by efficiencies and would hurt services.

But Mr Ryall said recent signs of pressure were no more than "business as usual" in the health sector.

"Every year DHBs seek to make savings so that they can meet the new pressures and policies that they may be wanting to do.

"It's never easy in any government agency to look to save money, but they do it.

"Technologies change, processes change. There are a number of productivity initiatives across hospitals making operating theatres and wards more productive - which means more service out of each health dollar."


Saturday: How deep the cuts go.
Today: Health.
Tomorrow: Crime and justice.
Wednesday: Housing and welfare.

- NZ Herald

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