Hospitals tied up in red tape, says chief

The chief executive of one of New Zealand's largest district health boards has resigned to go private - and has panned what he considers excessive bureaucracy in the public system.

"The amount of compliance and audit and monitoring is gobsmacking really," Dwayne Crombie, head of the Waitemata board since 1998, said yesterday.

"It's become an industry in itself and a lot of the time I wonder if some of it is more about protecting people's risks rather than really making a difference to whether people die in hospital or elsewhere. It takes a huge amount of resources."

The health system generally delivered good value for money, he said, but was bogged down in too much strategy, policy and monitoring.

He urged the sector to refocus on concrete improvements to patient care, like better drug dispensing and infection control.

Monitoring requirements had increased exponentially: some of it was needed, some was superfluous.

Dr Crombie said health services and workers were required to be monitored by a range of groups, including the Ministry of Health and doctors' professional colleges. Safety-standard audits, overseen by the ministry, took weeks.

"What we're doing is demonstrating that it should be safe by showing the paperwork, whereas we probably should be putting more of that energy into changing some of the systems to make sure we are safe."

The whole health sector could be more efficient if compliance costs were reduced, Dr Crombie said.

The ministry last night acknowledged that monitoring was time-consuming but said it was needed to ensure patients were safe and that taxpayers' money was spent properly.

A funding and performance manager, Les Stephens, said none of the 21 DHBs raised objections - in a ministry study - about the types of financial information the ministry sought.

The boards' industry association "did provide a useful discussion on reporting frameworks which the ministry is taking into account".

Dr Crombie, a public health physician, leaves in September to become CEO of Guardian Healthcare, a large owner of resthomes, geriatric hospitals and retirement village interests.

The 46-year-old said heading a large DHB was a tough job and after eight years he wanted a new challenge.

Among his hardest tasks was explaining to the public that many people who would benefit from elective surgery could not be treated because of limited money - a problem that would only worsen as the population aged and medical technology expanded.

His worst times included the killings and alleged attacks by Waitemata mental health service patients such as Lachlan Jones, who killed Malcolm Beggs then himself in 1999, and Martin Lyall, a Massey cook in his 30s who was accused of killing Kevan Newman in Henderson last November.

One of his high points at Waitemata was last year's opening of an upgraded Waitakere Hospital, bringing general acute and emergency hospital services to the western city.