Dialogue: Children an easy target

By DR ELIZABETH SEGEDIN*

There has been an extraordinary dearth of clinical reality in the finely managed Auckland District Health Board public relations programme that we have been handed over the past week, and it requires some balance.

It appears all too easy to target children's health services, and it would be nice to think that such wordy discussions might have reflected at least a modicum of what this means to patients and families. Unfortunately, it appears that our leaders' believe that specialised child healthcare is an optional extra based more on warm fuzzies than on a basic right to the same standard of care that adult patients get without a second thought.

One might have got the impression that the only hospital unit responsible for the board's budget blowout was the Starship, or that the $34 million project for cardiac kids was extreme.

There was no mention of the 15-fold amount being spent on adults under the Auckland hospitals rebuilding plan, a project which is on time and on budget except for the bits it left out - women, children and the elderly.



Senior managers, who have had six years to get to grips with their business, still do not appreciate that children's care requires different knowledge and skills to that for adults. Its origin in the different anatomy, physiology, psychology and diseases of children demands a separate infrastructure which is similar to, but not a duplication of, adult medicine.

The debate has been centred around capital outlay for children with heart disease and those who are critically ill. It should have been about getting value for money - consolidating related services to make the most of collective expertise and achieving efficiency.

This efficiency requires a critical mass of children. For example, the CT scanner at the Starship would be better used if all the children in the board's area had access to it.

Intensive care for children, which is also a subject of debate - has been shown to be more cost-effective than that provided for adults and even small pre-term babies. The death rate is low, the length of stay short, and most patients survive to lead normal, productive lives.

International studies show that introducing mediocrity to save money doubles mortality and the costs.

Surviving disability costs the country for a lifetime. This has to be done right or not at all.

At the time of writing, there are children in the Paediatric Intensive Care Unit from Invercargill, Christchurch, Waikato, and South Auckland. None is from the Auckland board's area. None is here because of a preventable disease and, in contrast to adults, no illness is self-induced.

If the board cannot afford to pay for this national service, what do the mums, dads and grandparents think we should do with these children?

Our facilities are seriously inadequate. Should the board pay the full bill for upgrading them to the standard given to adult patients around the country?

The parents and paediatricians in this country expect that the Starship will be there for these children. Our new chairman, our chief executive and the ministry are out of step with these expectations and the clinical reality that confronts staff daily.

They have failed to implement the tertiary review for children, which laid down a collective national vision for children's healthcare based on strong regional paediatrics and in which the Starship plays a role for the very sickest (read most expensive) children.

Of course children's health care costs more. Any parent can tell you that they require 24-hour attendance even when well.

The ministry's funding formula does not reflect this. At least the Starship Foundation's work has helped.

Let's get real about how best to deal with these costs. We either tell the country we are not going to treat such children at all, or we do it to the best of our ability. Cost-generating mediocrity is the worst option.

At least the chairman has brought this to public debate, albeit in a destructive manner. I agree that we have to get the best value for money. In this regard, consolidated, efficient and quality care for children is a cost-saving investment.

* Dr Elizabeth Segedin is clinical director of the paediatric intensive care unit at the Starship.

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