Healthcare woes Neoliberal symptom

The culture of avoiding problems at the SDHB, rather than fixing them, was deeply ingrained. Photo: Getty Images
The culture of avoiding problems at the SDHB, rather than fixing them, was deeply ingrained. Photo: Getty Images
A scathing report by the health and disability commissioner into the urology service provided by the Southern District Health Board was released earlier this month.  Patient C tells his story.

The first thing that I would like to make clear about my experience at Dunedin Hospital is that my clinical treatment was excellent when I was not interacting with the urology department.

It would be unfortunate if the highly competent and professional work of the bulk of the hospital's clinical staff were to be tarred with the same brush. I am, alive, well, enjoying a good quality of life and have a life expectancy consistent with my age.

This is in large measure due to the high quality of care I received from other departments.

The second point I would like to make is that, while I have received a letter of apology from the SDHB CEO, he is not at fault and has inherited this problem from the people who failed to respond appropriately to both other health professionals' concerns about the urology department's performance and to my own complaints about the service being provided.

Rather than Mr Fleming carrying the can, I would have liked to have seen the names of the seven SDHB employees who failed to act appropriately on that letter of apology. (I do not, however, want an apology from the secretary who banged the phone down in my ear.

She had been tasked, quite unfairly, with communicating clinical information to me when she was not a member of the clinical staff and was, consequently, under considerable stress.)

It may be that these employees have been appropriately censured out of the public eye, but it concerns me that employees who have practised a culture of problem avoidance are still in a position to perpetuate this culture. It was this culture of avoiding problems (rather than fixing problems) with respect to my getting my concerns appropriately investigated, that led to my final conclusion that I had no choice but to escalate my complaint to the Office of the Health and Disability Commissioner.

From my perspective, it is important that it is understood that I gave the SDHB every opportunity to deal with this problem ''in house'' and that those charged with actioning complaints failed to act appropriately, as has been shown by the Health and Disability Commissioner's determination.

I first had to point out the inadequate information available about accessing the complaints process, then a cursory and inadequate investigation was carried out. I then pointed out the shortcomings of this investigation and this led to my concerns coming before an SDHB committee with responsibility for complaints.

They too failed to investigate appropriately and I had to point out the inadequacies again and, also, that the opportunity not to involve the Health and Disability Commissioner existed if my concerns were dealt with appropriately.

A senior clinician was charged with reporting on the matters I had raised and we had a meeting, to discuss my concerns. An internal investigation was done. It was reasonably comprehensive but only identified some minor shortcomings which were, at least, addressed as a result.

Progress was being made but, in my view, the report avoided coming to grips with my core concerns about the quality of care being offered.

I had persevered because I felt that the existing and widely known problems in the SDHB had already negatively affected morale and that the opportunity existed for action to head off a crisis.

However, at this stage, I felt that the culture of avoiding problems, rather than fixing problems, was too deeply ingrained and I didn't have the energy for the fight.

Accordingly, I wrote a critique of the report, passed it on to its author and attached it to a complaint to the Office of the Health and Disability Commissioner.

The rest is, as they say, ''history''. The crisis has been exposed and corrective action has taken place, but what has happened in the SDHB needs to be understood in the wider context of other crises in other public sectors.

There is a persistent pattern in Western democracies of public sector providers being unable to provide adequate services. This goes hand in hand with a deliberate strategy of reducing funding in the name of finding ''efficiencies''.

The driver for this is an unproven belief that the private sector can do it cheaper and better and that the public sector should be forced to match this unproven level of efficiency or submit to privatisation. The motive is to privatise, the means is to reduce public sector funding until services can no longer meet needs, and then to use this as a rationale for privatisation.

The ultimate and desired outcome for those who have hung their political hats on trickle-down economic theory is that the state sells healthcare to large foreign-owned health insurance companies and the money is used for tax-cuts to stimulate business and increase the crumbs that fall off the table to a level sufficient to keep the bulk of the citizens happy. The problem is the lack of evidence that this works.

The USA spends twice as much on healthcare than its nearest developed world expenditure rival and yet gets the worst health return ''bang-for-bucks'' in the OECD. Mixed models, where public sector healthcare is well supported and private insurance is an opt-in for those who can afford it, perform best.

My argument is that the SDHB has been inadequately funded and is in the decline that the Rabid-Right-Wing of economic theory has forced upon it.

Under these conditions, the quality of administration and management is affected first, as compliant, but not particularly able, people are brought in to implement cuts and clinical services come under greater and greater pressure.

Dealing with problems becomes onerous, time-consuming and expensive.

Administrators look the other way and clinical staff don't have the time to make a stand as the demands to do more with less increase.

Is this ''loony-leftyism''? No, but the dominance of right-of-centre politcal and economic thinking in recent years has left rational centrist policies out in the cold and public services in crisis around the world.

Comments

Most of us have lived in Dunedin long enough to know that there are significant structural conflict of interest problems in the operation of health care in the city. Too many consultants are operating private clinics in competition to themselves as employees of Dunedin Public Hospital. This means that they have an incentive to restrict the supply of their time through the public system so that patients are more likely to engage them in their more lucrative private clinics. Is this how healthcare operates in the rest of the world?