It didn’t work in the United Kingdom! How many times have you heard this when a positive idea is promoted. What has anything to do with whether it worked in the UK or not? For a start the UK has a strange health system to say the least, some pretty awful health facilities, dealing with an enormous population compared to New Zealand which makes comparison of medical services chalk and cheese.
So what am I talking about? The column in a local newspaper where an “Expert” expressed scepticism over a suggested possible cooperation partnership between a DHB, in particular Counties Manukau DHB and a private hospital, Franklin Private Hospital, presently under construction in Pukekohe and due to open stage one in 2021. This system is known as Private Public Partnerships “PPP” in the UK. The suggestion was raised by the founding doctors of the under-construction Franklin Private Hospital regarding possible cooperation with Counties Manukau DHB. This possible co-operation was suggested for the second stage of the build of Franklin Hospital.
Dr Richard Edlin, Health Economist and head of Health Systems Group has claimed private and public partnerships have resulted in higher costs to the taxpayer in the UK. As a retired member of parliament I look back on decisions involving New Zealand’s health system over the years including the currently far from efficient existing District Health Board (DHB) system. This is a problematic system throughout New Zealand, seemingly incapable of managing its financial operations or tight Government Health budgets. Dr Edlin, are you seriously suggesting DHBs run more efficiently than private hospitals? You would be joking! Private hospitals have to operate within their budget and provide top standard services and at the same time without Government bailouts. Some DHBs constantly over run but have the luxury of asking for a bailout from Government each year. This is quite understandable as they are expected to be the end provider to the public regardless of the individual patient’s financial capability, under our present Public Health System. Nursing staff are often the first financial cut the DHBs make resulting in overloaded and overworked nurses, who frequently start to assist a patient, open sterile bandages and equipment, then get called to assist with another patient. The now non-sterile bandages have to be discarded, at a huge cost and waste. Overworked young resident Doctors work killing hours, doing their residence service in our public hospitals. This is extremely dangerous in any work environment but especially in a Hospital. The waste and costs in Public hospitals due to insufficient overloaded professional medical staff is a major problem for DHBs to daily deal with.
I have absolutely no criticism of nurses. They are truly wonderful dedicated people, this also applies to the overworked, captive young resident Doctors; it’s simply the understaffed, overloaded working conditions in which they work long hours which must be of concern to us all.
Where Dr Edlin’s criticism falls flat is, a considerable number of non-acute hospital cases are already passed on to private hospitals so it’s happening already. The Doctors building the Franklin Private Hospital are acutely aware of this and the enormous growth in the population of Franklin and South Auckland, hence their suggestion. We are miles from Middlemore and Hamilton DHBs. Hospital services are bursting at the seams and the stated intention to negotiate a Private Public Collaboration “PPC” (the first in New Zealand) has to be the direction of the future. Dr Edlin says this hasn’t been discussed yet with the DHB, however the Franklin doctors have signalled it’s the direction they plan for the second stage of their new Pukekohe Hospital.
Specialists already work in both systems, undertaking operations in both public and private hospitals and the public get great value from this service. Dr Edlin suggests “It is rare small public hospitals could match the costs of large public hospital” Really! He says the larger the scale the cheaper it’s going to be!
This was the same argument used to promote the Auckland Super City, which doesn’t work, costs far more than the 8 individual councils ever did, whilst its services performance has continued to drastically drop, yet rates have increased and calls for handouts from Government have become the norm.
I have 22 years’ experience as a City Councillor of the old efficient Auckland City Council, a former member of the old Auckland Regional Authority and Commerce chair as a Government Member of Parliament, and therefore have experience in both areas, local and central government.
I still recall the old system “of use it or lose it” where the old hospital boards would forward a budget to Government and prior to the next funding application would often discover the allocated funds they held had an unused portion which should be returned to Government as surplus. So a spending spree inevitably took place to ensure the next funding request would increase, not reduce, funds available. I recall a large Auckland storage facility being discovered with new, but obsolete, unused medical equipment in Auckland purchased in this way. This was the old extravagant accounting method, which thank goodness has long ceased. This is why government now allocates funds and approves specific equipment purchases and why no surplus funds now exist.
I have been a patient in Middlemore hospital for major surgery and can only speak highly of the dedicated staff. This DHB needs all the help it can get, and recovery of costs from humanitarian work adds a huge load to the operational administration of the hospital. Private hospitals don’t have this to deal with. Having said this however, Dr Edlin cannot seriously believe the DHB system is cheaper to run or that bigger is better or more economic.
I believe the DHB should look seriously at negotiating with the Franklin Private Medical facility whose doctors are highly regarded and appreciated in the community.
I congratulate the forward thinking by the doctors involved with the Franklin Private Hospital and their stated intention to work towards establishing a private/public collaboration with Counties/Manukau DHB, and to assist by taking some of the heavy load of non-acute public patients currently under public care of the DHB.
Best wishes to all for 2021 and may it be a better year.
Trevor Rogers is a former Member of Parliament, serving two terms from 1990 to 1996.