When it has been widely acknowledged for years the country’s health system has fragile and fragmented information technology, it is difficult to understand how cutting more than 1000 IT jobs will help.
The Digital Health Association has gone as far as warning further cuts to data and digital services funding and workforce could have catastrophic consequences for the health system.
Its views should not be taken lightly. According to the HNZ website, the association is an industry group of health software companies, partners and healthcare providers with many supporting members, including educators, researchers and public servants. This group of organisations and people "represent most of Aotearoa New Zealand’s health technology partners".
It works with HNZ to help develop ways to use technology in health, the website says, but the association is saying the government is not listening to it.
According to DHA’s chief executive Ryl Jensen, the 1120 redundancies expected within HNZ’s data and digital teams would be 47% of the workforce, many of whom were responsible for keeping the health system’s ageing IT systems operational.
The government has previously been warned half of the critical IT hardware in hospitals is past its use-by date. In its briefing to incoming Minister of Health Dr Shane Reti a year ago, HNZ described the data and digital situation as complex, involving 28 entities, with varying degrees of maturity and quality.
Capability and investment had varied across the country, resulting in a patchwork of about 4000 systems which were not integrated, often out of date, with no effective back-up.
Significant resources were needed to maintain old systems, particularly those reaching the end of their lives, contributing to more serious and more frequent service outages.
Ms Jensen warns without ongoing critical support the health system could face significant disruption, and frontline clinicians could struggle to deliver timely and efficient patient care.
She said good progress had been made in the past two years on systems to transform how the system was connected, despite significant challenges. Cuts risked undoing that progress as well as affecting projects designed to bring the health system into the current century.
A lack of proper investment in digital health initiatives meant there was a risk of exacerbating the postcode lottery in health, where quality and accessibility of health services depend heavily on where you live.
What happens next depends on what is in the new 10-year Infrastructure Investment Plan and National Asset Management Strategy which was expected to be delivered by HNZ and considered by Cabinet this year.
There may be some nervousness about how all of this might affect data and digital spending on the Dunedin Hospital rebuild.
Although Dr Reti is reported to have told a DHA event in July the $225 million allocated for data and digital services in the rebuild in 2022 was being retained, that was well before the government announced its review of the inpatient building part of the project.
Funding for the first phase of this spending, in the outpatient building, has been released and HNZ has said when the new building opens, modern digital infrastructure and solutions will be in place, including digital "wayfinding" services, patient check-in kiosks, digital signs and Wifi connectivity. If the national plan will involve considerably more input from the private sector, it is hard to see how that will prove cheaper.
Whatever is proposed must provide for sustaining institutional understanding which can concentrate on the long-term, rather than merely accommodate a succession of organisations making a quick buck. Lack of a co-ordinated, agreed long-term focus has much to do with how we got into this mess in the first place.
It would be good to see some focus on the IT question during the second parliamentary scrutiny week which starts today, but the issue will have to compete with a plethora of ongoing concerns about the health system.
