Sick children PR nightmare

Everybody loves the Starship, but health administrators facing a budget blowout are asking tough questions about it, reports MARTIN JOHNSTON.

Graeme Edmond is worried about being labelled "the bloody arsehole CEO who's anti-children" for sparking controversy over rationing of health services.

But as chief executive of the loss-making Auckland District Health Board, he has been forced to talk of trade-offs between costly projects such as shifting children's brain surgery to the Starship hospital and better access to GPs in poorer suburbs.

The timing could not be more worrying for the Starship Foundation (prize celebrity: Lucy Lawless), which has just started an appeal for another high-tech project, the $33 million plan to set up a separate children's heart unit and expanded intensive care unit in the hospital.

But the Auckland board faces a deficit of $72 million or more and is under pressure from its new cost-cutting chairman, Wayne Brown, and the Government to stop bleeding cash.

This is putting the expansion of some of the money-hungry services at central Auckland hospitals, the most specialised in the country, in doubt.

In particular, Mr Edmond is asking tough questions about the Starship, the country's premier children's hospital.

"We're going to have to lead the debates [such as] does the country wish to pay for the degree of specialisation at Starship children's hospital," he says.

"It's not right that I get accused as the bloody arsehole CEO who's anti-children."

He adds: "We're happy to do those specialised services; we want to." But he says his job is to point out, "This is what it costs for these children. They're very needy people, but they are small in numbers".

The Government has already ordered the board to rethink three projects: a heart facility and expanded intensive care unit at the Starship, more beds for the National Women's part of the new super-hospital at Grafton, and a new rehabilitation centre at Green Lane.

The Starship is one of only two children's hospitals in New Zealand. The other is KidzFirst in South Auckland. The 196-bed Starship provides "secondary" care to Greater Auckland and complex "tertiary" treatment to many patients from the rest of New Zealand and the Pacific.

Managers forecast a budget blowout of $6.5 million this financial year - losses of about $17,800 a day.

The celebrity appeals for expensive projects roll on, but Mr Edmond is re-examining the plans to do children's brain and heart surgery at the Starship. At present they are done alongside the adult services at Auckland and Green Lane.

"We do paediatric neurosurgery, but we do it in with the adults at the moment. If we're moving it in to Starship, that requires a lot of duplication."

Mr Edmond acknowledges the importance of these services, but asks: "What about all the Pacific Island kids and Maori kids who aren't even getting access to basic primary healthcare ... Why do the media focus on those ones at the expense of the others?"

After the children's hospital opened in 1991, the Starship Foundation and the Friends of Starship were started. These high-powered additions to the Auckland charity circuit have raised $15 million.

The foundation has attracted a glittering list of stars, who add pulling power to its fundraising campaigns. Among them are Lawless, children's TV presenter Suzy Cato, newsreaders Simon Dallow, Alison Mau, John Campbell and Carol Hirschfeld and rugby star Jonah Lomu. Corporate backers include ASB Bank, Sky City, Mercury Energy, The Warehouse and Hasbro.

Over the years the foundation has established close links with corporate backers and the media. Its vice-chairwoman, Rosie Horton, is the wife of Michael Horton, former managing director of Wilson & Horton, publisher of the Herald.

Its communications manager, Andrew Young, a former Herald health reporter, is adept at packaging story ideas - with easy access to vulnerable child patients, knowledgeable doctors and irresistible celebrities.

The stories often feature a TV star, such as Lawless, a foundation trustee, caring for sick children or pleading with the public to dig deep for projects such as children's brain-surgery equipment or a multi-agency centre to deal with child abuse - all apparently sensible improvements to services.

Mr Young said Lawless was unwilling to be interviewed because of other commitments and a wish to keep the focus on the hospital and its work.

When she launched the Safe and Sound appeal for the multi-agency centre, she said she was shocked by the case of 3-year-old Tangaroa Matiu, beaten to death by his stepfather for soiling his pants. Lawless shed tears and put up her hand to help.

When Mr Young is asked about the foundation possibly paying for primary healthcare, he replies: "Our projects are based on the hospital's needs and are prioritised by the hospital in consultation with the health board. They are hospital- or board-driven. They are not Starship Foundation-driven."

But Mr Brown, the new board chairman, is questioning the foundation's priorities.

"I'm attempting to gently nursemaid it towards raising funds for public health initiatives for children in deprived areas.

"But there are not so many opportunities for photos with blue ribbons and scissors in your hand, but it's probably more valid expenditure."

He cited the board's health needs analysis, which revealed significant children's health problems in poorer suburbs such as Glen Innes.

"We are required to take that into account when we prioritise health spending ... that funds should be spent to lift those health standards in children possibly before the more expensive paediatric clevernesses come into play."

South Auckland, an area of enormous health needs among children, largely because of poverty, has its own fundraiser, the South Auckland Health Foundation.

"We're not asking for the icing on the cake, we want the cake," says one insider, although the official line is that the two foundations are mutually supportive.

"Starship Foundation raises awareness," says David Clarke, chief executive of the Counties Manukau District Health Board. "They purchase critical bits of equipment and facilities the Government won't normally finance.

"I think it's fantastic. A lot of South Auckland children get tertiary treatment in Starship and a strong tertiary paediatric service in Auckland District."

One of those services, the children's heart unit at Green Lane Hospital, is fighting for the $33 million plan, involving $5 million from the foundation, for a stand-alone unit and expanded intensive care unit at the Starship.

The heart unit is now largely integrated with the adult unit. Doctors such as Green Lane children's heart specialist Dr Nigel Wilson say there is no room for it at the Grafton super-hospital and that if it was forced in there, specialist staff would start to leave and new staff would be hard to attract.

But with a crumbling budget, the board has made it clear it cannot afford First World services.

Children's heart treatment mainly involves inherited abnormalities, in contrast to adults' treatment, which is mainly of blocked coronary arteries. The two areas have developed as separate specialties.

After surgery, patients need to go to the intensive care unit. By putting the heart unit at the Starship, the doctors argue, it would boost the viability and efficiency of its intensive care facility, which would be expanded.

They fear that for "catheterisation" - investigations and minor surgery involving tubes inserted into the heart through blood vessels from the groin - they will have to transfer patients from the Starshipto the adjacent super-hospital.

They say this would boost the risk of patients - often sick, fragile babies - suffering complications or dying because of the transfer and the distance from staff and equipment for resuscitating infants.

Splitting treatment between the two sites would be more costly and less safe, said Dr Liz Segedin, the clinical director of the Starship's intensive care unit.

The board has not decided the issue, and doctors still hope to persuade Mr Brown, but all the noises he has made so far point in the direction of more integration of services, not less.

Dr Scott Macfarlane, the Starship's clinical leader, points to the British inquiry into the Bristol Royal Infirmary. It found that one of the reasons for an unacceptably high death rate among child heart surgery patients was that they were being operated on in a building separate from where they were being looked after.

"It's analogous to being operated on in the [super-hospital] and being brought back to Starship for intensive care."

Dr Macfarlane recalls the board's hospitals' "options analysis" last year, which identified potential areas for cost cuts, but he says doctors "were extremely fearful of the consequences to the public" if any of the options were adopted.

"The Ministry of Health said, 'Yes we want you to cut costs, but you can't do any of these things. All these services need to continue at the current level of quality that you're providing'."

Now the board is going through the exercise again as it plans the next year's budget, and Dr Macfarlane and other hospital leaders have been asked how to cut back on areas where they have exceeded the contracted numbers of patients.

He says: "You can ethically do it only if there is a contract between the Government, the ministry, the population and the provider that there will only be a certain amount spent on health and when it runs out, that's it."

nzherald.co.nz/hospitals