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Reading the manifestos of the brave people standing for election to the hospital board has raised many questions concerning the qualities required of an ideal candidate.
Many important factors requiring urgent attention were identified by candidates. Some asked why these had not been addressed in the past, and many potential solutions were suggested. A number of common themes of concern emerged.
The most basic challenge is the longstanding and progressive underfunding of the health system. Insatiable demands vastly exceed available funds.
This is a national issue, with particularly acute effects here in the SDHB. Realistically, it will not be corrected during the next three-year term, if ever.
Our new board members will need to learn to perform the juggling act of making do with what is granted, while making effective and well-reasoned representations to the funding providers for a more appropriate funding model.
These efforts should be demonstrably visible, without any pretence that simply fulfilling ministry requirements also satisfies the requirements of the community. Honesty is required. In the meantime, outstanding efforts are being made by people like Phil Bagshaw and his colleagues to bridge the gap with free community clinics.
Good and efficient management is essential, but many candidates have noted excessive layers of management not dealing directly with patient needs.
The purpose of some overcomplex reporting systems could be queried, and many eliminated. Rationalisation is required, with a positive patient-oriented team ethos between clinicians and managers.
We are fortunate to live in an era where prevention is preferred to cure; screening programmes are a good example. Although these are very cost-effective, they take many years, often decades, to reach full impact, and they do not eliminate sporadic cases entirely. Over the next many years patients presenting with all levels of disease will still require costly attention. Immunisation and fluoridation are also important preventive measures in diminishing patient morbidity and health expense.
Non-communicable diseases such as obesity, diabetes and heart disease also have an element of being preventable. Promotion of healthy lifestyles is relatively inexpensive, but needs to be part of national drives and legislation to change population behaviour. While each DHB can play its part, this problem is bigger than the individual boards. National co-ordination of public health is an essential element for this to happen.
Cancer has recently been a focus of attention. Incidence will rise with our increasingly ageing population. Some can be prevented, and adequate measures should be established to deal with the whole process required from screening to treatment.
Hopefully, a national cancer agency will help with this, but success will depend on what advice is offered, how well that is heeded, and whether funding is adequate for its implementation. Suitable staff and facilities must accompany the recommendations. While drug therapy can be lifesaving for some, budgets for these expensive drugs will be stretched, and value for investment carefully gauged.
Frustration has been expressed at many levels about the time taken for investigation and treatment of symptomatic patients. Expensive equipment must be used efficiently to gain maximum benefit. For example, paying for an extra shift of a radiographer to scan a number of patients is much more cost-effective than having a patient linger in a hospital bed awaiting investigation. Technical advances have enabled tests to be performed much more efficiently, often with telemedicine facilities benefiting patients in rural areas.
Waiting lists are another source of frustration. While it is difficult to avoid them in times of resource scarcity, they are subject to manipulation. If people do not qualify for a waiting list, it does not mean they are not suffering or that they do not require the treatment just because they are not as bad as those on the list. These "waiting patients'' should be recorded, and representation made concerning the efficacy of available management.
Teamwork needs to involve all parts of the health sector, from primary and secondary care, through support and technical services and management. Until all sectors work as a well-co-ordinated team, inefficiencies will remain. Staff in rural hubs need to feel part of the health team. The ethos of the DHB must improve to include positive communication throughout the organisation, including board members. They need to know how the troops at the workface are faring.
Last but not least, none of the candidates included the Dunedin School of Medicine in their considerations published in the ODT. While it must be accepted that this is not the primary concern of the SDHB, repeated inquiries and surveys have established that the DSM and SDHB are of mutual benefit to each other, and benefit services to our community.
The academic and clinical staff both bring expertise to our city and region. The quality of our future doctors depends on the quality of the learning they experience in our institutions. This is our medical school and deserves our strong support.
- Gil Barbezat is an emeritus professor of medicine and was previously head of the gastroenterology service.