While there is optimism from some that the protracted contract dispute between the Southern District Health Board and Waitaki District Health Services will soon be resolved, there is a lot of work to do before a deal is in place and the two sides have only six months left before the current contract runs out. Hamish MacLean reports.
Incoming Waitaki District Health Services (WDHS) chairman Chris Swann says he is "very optimistic" about the future of health services in the district.
But the changes coming to Oamaru Hospital — and for healthcare in the Waitaki community — remain unknown, and some are reserving judgement until the details of Waitaki’s new "model of care" emerge.
Mr Swann, who takes over as chairman in the new year but has served on the board of directors since 2007, said the clinically led service review completed in July by WDHS and the Southern District Health Board (SDHB) presented the health company with "a real opportunity now to really model how all our services get delivered into the community".
However, he also noted the review recommendations were "reasonably general".
"There is going to be more emphasis on caring for people in their homes and in the community; that’s going to be quite a change," Mr Swann said.
"IT [Information technology], information systems and the sharing of information between the hospital, the GPs, SDHB, everybody, is a very exciting thing.
"There’s a whole lot of very exciting things going to happen.
"At the end of the day, what we’re there about is the people in the community and giving them the best possible healthcare. And I think we can deliver them even better services than they are getting now — better health outcomes through this new model."
Talks to renew the contract for health services in the Waitaki district officially began in September; the current contract expires on June 30. Facing large deficits, the SDHB proposed 5% funding cuts for its rural hospitals in April 2015. WDHS — and the Waitaki community — opposed the cuts. In July 2015, 2500 people marched to Oamaru Hospital to protest the proposed cuts. The health company is the only rural hospital to resist a new contract with the annual funding cuts imposed.
Before negotiations began, in April last year bed numbers at the hospital were cut from 30 to 24 and hospital management cited ongoing underfunding — including the SDHB withholding money it owed to WDHS — as a big factor in the bed cuts.But management also warned the cuts to service were a "starting point" of a loss of services in the face of the funding cuts proposed by the SDHB.
The health company threatened a boundary move to the Timaru-based South Canterbury District Health Board as an alternative to another contract with the troubled SDHB. In late 2015, the Otago Daily Times reported high-level advice to the SDHB showed losing Waitaki healthcare could "seriously impact" services at Dunedin Hospital.
SDHB executive director of planning and funding Sandra Boardman said that with the review, the proposal for a funding cut was "off the table" and the new model of care would "be reflected in the next contract".
When the Otago Daily Times asked Mrs Boardman whether the service review’s recommended changes would be implemented before the current contract expired, she did not answer the question directly, but instead said: "The implementation of the recommendations has already begun."
The review calls for, among other things, "community-based services", "co-ordinated urgent care", "services close to home" and improved technology, including upgraded broadband to allow for "telemedicine".
Dr Carol Atmore, the general practitioner and clinical adviser contracted by the SDHB to lead the review, said the changes to the way health was provided in the district would require "evolution, not revolution".
From a patient’s perspective, "things will happen more quickly", she said. And she described one of the changes touted by the SDHB, a so-called "clinical care hub", as "enabling the working together more closely that happens anyway". Late last year, Oamaru general practitioner Dr Jon Scott, who has worked in Oamaru for the past 20 years and served as a review team member, said the review recommendations contained "a lot of words".
"But I actually have no idea what it really means," he said.
"It’s just words. I don’t actually know what all these things mean."
When asked about his level of optimism — on a scale of one to 10 — about having a good deal with the SDHB in place by the middle of this year, he replied, "three".
"What have the SDHB done to enhance trust in what they say?" he asked.
"What have they done to actually show trust?
"They are under financial pressure so they are cutting costs. They then go ‘We are cutting costs, we’ll have the review’.
"It’s all very laudable to have nice words, but what does it actually mean in reality for Oamaru Hospital and Oamaru services?
"If the review comes back and says we want to increase the funding, is the SDHB going to increase the funding? No, they’re not."
When the Otago Daily Times asked Mrs Boardman whether an agreement had been made for interim funding if a new business model was not in place by the end of the current contract, she replied: "It has been agreed that the new business model will be in place."
Last month, the Otago Daily Times asked how much was spent on the joint services review and the question was logged as an official information request.
Interim chief executive Chris Fleming replied last month.
"Direct costs to the [SDHB] included payment for time of the clinicians involved in the project team who were not either direct employees of SDHB or [WDHS]. The only other further direct costs incurred were for room hire and catering for the four community engagement meetings," he wrote.
"Costs for clinicians on the project team totalled $13,572.45.
"Room hire and catering totalled $748.08.’’On September 13, the WDHS board appointed a negotiating team of: directors Mr Swann and incoming WDHS deputy chairwoman Helen Algar; health company accountant Tony Evans; staff members Mandy Collins and Dr Peter Rodwell; and WDHS chief executive Robert Gonzales.
Mr Gonzales said he could not comment on what future levels of funding would be for the health company but said the "devil is in the details" when it comes to establishing a new model of care after the joint review.
"It’s a matter of wait and see, still. We’re just waiting now to engage and get our teeth into it."
Timing was tight for the two sides to produce a business model before the current contract with the SDHB ran out.
Further, he said Oamaru Hospital had been filled more regularly over the winter with reduced bed numbers in place.
Review recommendations
Community-based services: Including a holistic patient-centred approach where those in care make decisions about their own care.
Co-ordinated urgent care: A streamlined first response system, to reduce pressure on ED.
Improved post-hospital discharge: Investment into primary and community-based services.
Services close to home: Increase outpatient/specialist services locally.
System communication and co-ordination: Improve technology, including upgraded broadband to allow for "telemedicine".
Workforce enhancement: Enhanced roles for nursing and Allied Health, including "upskilling" and education.
