Why bureaucrats target Starship

By MARTIN JOHNSTON health reporter

The renaming of the Starship looks, on the surface, to be simply a series of badly thought-out ideas carried out in even worse style.

But the wrangling over what to call the hospital - first children's services and now just a "department" - only hints at power struggles that have been going on for years.

Opposing the Auckland District Health Board and its cost-cutting chairman, Wayne Brown, are the fundraising Starship Foundation and many of the board's senior doctors.

A source said yesterday that Mr Brown, appointed by Health Minister Annette King in 2001, had long had the names of Starship, Green Lane Hospital and National Women's Hospital in his sights. "He tried to change all three from day one."

Mr Brown, supported by the rest of the board, quietly got his way last July when they became children's, women's and cardiac services of the new Auckland City Hospital at Grafton.

The only document about this in the July meeting agenda is a one-page list of the names of clinical units and departments in the new hospital, scheduled to open from this October. It does not mention Starship.

The board did not consult the hospitals' staff or other interested groups and drew no attention to the changes. No one outside the hospitals noticed until last week when controversy erupted among doctors nationwide, apparently over plans for new signs, and one told the Herald.

Starship has won a partial reprieve and now Green Lane and National Women's staff have renewed their fight to keep their names.

But the naming rows are only a symptom of the deeper battles - battles over Starship's national status not being matched by adequate funding; integrating four hospitals into one at a time when the best practice is considered separate services for children, and the board's bid to force the hospital-focused Starship Foundation to expand into community-based healthcare.

Mr Brown's main argument for renaming the three hospitals is that they are being integrated into a single entity, the new hospital, which is physically connected to Starship.

He said the decision to merge the acute services of the board's hospitals, including Auckland Hospital, and build a centre for day surgery in Greenlane - a plan costing $450 million but intended to save $40 million a year - predates him.

Green Lane must be renamed, he has said, otherwise people with heart problems could wrongly be taken to the suburb from which the acute hospital will have departed (a problem staff said could easily be fixed by a name like "Green Lane cardiac unit, Auckland").

Mr Brown has said the National Women's name attracts too many patients who should be seen at women's wards elsewhere in Auckland. Similarly, Starship - named to help put children at ease - should not be a place designed to attract patients.

But his statements during the renaming row also showed it is about putting hospital specialists in their place. "There's nothing special about the children's hospital," he has said.

This is a message he has spread widely. A National Women's source recalled a meeting with Mr Brown: "He told us there was no room for groups in the organisation who feel they are special or different."

But the message is poison to doctors at Green Lane, National Women's and especially Starship.

Green Lane clinical leader Dr Margaret Wilsher said scrapping her hospital's internationally renowned name made no financial sense because it would make it harder to attract research money and to attract and retain top staff.

Her Starship counterpart, Dr Scott Macfarlane, said his hospital WAs being "homogenised" - put through a blender that wipes out its status as a national centre of expert children's care and converts it to a local facility.

The process has been applied to Starship's management structure, its planned lack of a main entrance separate from the adjoining City Hospital's main entrance, and even to its new external paint job, off-white to match the rest of the site.

The general manager's job had been merged with the equivalent position at National Women's, and radiology, anaesthetics and operating theatre management had been integrated with adult services, reflecting changes at all the hospitals. (In contrast, children's heart services, coming from Green Lane this year, will be in Starship rather than the new adults' hospital, but only because of a protracted battle and compromises.)

All this, Dr Macfarlane said, was happening as British health services were being compelled to develop separate services for children following the report on failings at the Bristol Royal Infirmary.

The inquiry panel said children must be cared for in a child-centred environment, by staff trained in caring for children and in facilities appropriate to their needs.

Otago University Professor of Paediatrics Barry Taylor agreed: "The underlying issue is identifying that children in New Zealand need a different service from adults."

Or, as others say: Children are not just small adults.

Mr Brown rejected the British comparison. "Britain has a huge economy. Compare us with Ireland.

"I'm sure you will find a lot of things in that hospital [Starship] that aren't as good as New York either, but we're doing our best."

And in line with Government priorities, the board wanted to beef up primary healthcare.

Mr Brown has questioned some of the Starship's "expensive paediatric clevernesses" paid for by the foundation.

Reflecting a widely held view on the board, member John Retimana said the name change was linked to the board's wish that the foundation start raising money for community healthcare projects as well as equipment like CT scanners.

"They are too narrow in their presumption that everything should hinge around Starship."

Foundation spokesman Andrew Young said the group raised money for projects in consultation with the board and Starship hospital.

The foundation would be happy to look at any business cases for community projects the board wished, but none had been put forward, he said, despite Mr Brown repeatedly characterising the foundation as only interested in hospital projects.

Many doctors also saw the renaming as a board attempt to rebrand Starship as a local facility rather than the national one it is, with more than 60 per cent of its patients coming from outside central Auckland.

This created a quandary for the board - charged with improving the health of Aucklanders - due to the inadequacy and uncertainty of state funding for some national services.

Paediatric Society president Dr Nick Baker said this problem could be solved in children's care only by funding Starship as a national service, rather than leaving it to a single district health board.