Deprived occupying beds

By Tom Clarke

Social deprivation is playing a major role in the growth of hospital admissions in Counties-Manukau, says the new general manager of integrated care and development with South Auckland Health, Joe Howells.

He says there is a 13 per cent compound growth in adult hospital admissions and a 10 per cent growth in child admissions in the region, compared with a population growth of just 2 per cent.

While some of that is because of an ageing population and a big population of young people, Mr Howells says social deprivation is also playing a major role.

In areas of higher deprivation hospital usage is 13 times that of the most affluent areas. These figures are too high, he says, and it is imperative that they are turned around. His aim is to reduce these admissions and he believes integrated care is one way of doing that.

The concept is based on South Auckland Health developing partnerships and programmes with general practitioners to improve the coordination of care.

Mr Howells says integrated care - the "frontier" of health care - is the next big area of health reform.

"There's quite a bit of work being done in the primary sector and the hospital sector to make them run better in their own right, but there's not a lot being done in making them work more effectively together, and that's what this is all about," he says.

"It's combining the strategies of both in disease management, concentrating especially on those serious chronic diseases which are a big issue in South Auckland, like diabetes, respiratory disease, heart failure and asthma.

"Instead of a GP managing a case in isolation and that patient occasionally getting so ill they end up in hospital through no fault of their own or their GP, the idea is that we pool the combined resources of our respiratory unit and the GP, to give the patient the best treatment to keep them out of hospital."

Under the integrated care concept, GP clinics and the hospital's specialist clinics would ideally be combined and would operate right in the heart of the community.

Such clinics already exist in Takanini and Pukekohe, but Mr Howells is anxious to see others established or improved, especially in Otara and Mangere.

"Eventually there will be a lot of clinics and we expect they will cover all of the mainstream specialties," he says.

In the United States, the best managed parts of the health system have a bed ratio of about one bed for every 1000 people, compared with the worst managed areas where the ratio is four beds per 1000. Mr Howells says New Zealand falls about midway in that range.

Mr Howells has had 10 years in health management in both the private and public sectors.

He was previously general manager of ambulatory care at South Auckland Health, where he was responsible for introducing the super clinic and ambulatory care concepts, which also placed emphasis on providing specialist care outside the hospital setting.