Health Cuts Hurt

HCH Achievements

Health Cuts Hurt Incorporated

Chair’s Report 2006

It is hard to imagine that a year has gone past since I became the Chair of Health Cuts Hurt. In writing this report I have found it interesting to reflect on our direction and where we want to go.

We achieved what we did not think was possible in having a member elected to the Health Board, the next question to which was “now what?” HCH members all would have different expectations as to what could be achieved by having a member on the board.

It is my opinion that Heather has done HCH proud in her conduct on the board, both for her integrity and her strength in adhering to her beliefs in effective health care for all Cantabrians in the face of intimidating incidents. The fact of the matter is that one person alone cannot change Government policy and the best HCH can hope for is what Heather is doing now and has been doing since her election to the board. Heather has gained respect from other board members whilst not compromising her beliefs. One person alone cannot re-route national, and indeed international, directions in public health. Grandstanding and holding aloft two-fingers might make good press and elicit a “yeah, you tell ‘em” from some in the community, but martyrs are not much help in the long-term and the long-term is what I believed HCH to have a vision of.

This brings me to the question I posed earlier, that of “now what?” I think it is fair to say that this past year has lacked the oomph of earlier times. The Charity Hospital Fund Raiser “presence” was a positive event and lots of fun, but media coverage was surprisingly disappointing – not that that was the fault of HCH. Since then things have been quiet for the group apart from the odd contact from journalists in The Press. I find it disappointing that the media seem only interested in rock throwing, as this is a limited and in the end, rather futile pursuit. Then again, is this what the majority of members believe that is all we can do, or should do?

It has been nearly two years since having a website was agreed upon but this is still not up and running. This is a real shame as the web is an excellent means of getting our name out there and drumming up support. Good ideas were put forward for topics for HCH to focus on but such ideas were not followed up on. Possibly this is the inevitable dip in the lifecycle of a lobby group. We all have busy lives and many of us have involvements with other political groups, which is why now is a good time for HCH to evaluate where it is going, where it wants to go, and the elected officers needed for that direction. Time is moving on and local body elections are not far off.

We all have to be realistic as to the time we are all prepared to commit to HCH, the resources we can raise, and whether we are all in agreement on the group’s direction. Now is the time for each member to evaluate what he or she wants for Health Cuts Hurt.

To end though, I have to say that I have found my year as Chair both an educational and enjoyable experience. HCH is a mix of people who hold a range of beliefs and yet have come together, overlooking those differences, in order to make a positive difference in the area of health for those who need it most. The sense of camaraderie is important to our group as we keep moving forward, and whilst our resources have been limited, the generosity of members and commitment so far has seen us achieve more than I believe any of us had initially expected: we have one member on the board and the media now regularly approaches us for comment. Building on this, I want to see our good name become a household name in Canterbury and our membership base grow. If HCH can maintain what it has so far and build on it, who knows how far we could take this group.

Eleanor Carter
HCH Inc Chair’s Report 2006

CANTERBURY DISTRICT HEALTH BOARD REPORT 2006

It’s amazing to think that I am now half way through my term as an elected health board member. It has been a steep leaning curve for me. I did not know what to expect on the Board except for hostility after the roasting HCH had given the Board over the year or so prior to the elections. There was some of that but not as much as I expected.

I think that most of in Health Cuts Hurt realized that the CDHB, like other health boards around the country, grappled with doling out portions of its bulk funding in the best possible way in its view. Despite our differing political views, those of us in the newly formed lobby group were all agreed there needed to be an improvement in the health system. Some of us wanted to see professionals working better, even harder, to deliver good health outcomes especially operations for people in need. Many others might have seen better wages and more workers as being the way to achieve these outcomes.

We are probably agreed that it would be better if salaries were outside the bulk funding the CDHB has to manage and distribute. Wages and salaries are causing the organisation to haemorrhage. In my opinion, this should be a national issue and not one for individual DHBs to sort out.

There are some unalterable facts that have to be dealt with:

• The CDHB has around $8 billion annually to distribute for health provision. There is no other money in the pipeline.

• Some areas in health (e.g. Disability) are paid directly from the Ministry of Health and are not part of the pot.

• The pot has to cover all areas of health (not directly funded by the Ministry) and this includes primary (G.Ps etc), secondary, and tertiary (e.g. hospitals/operations). Therefore, the hospital system (although the area most overspent) is only part of it. The pot covers a multitude of different contracts: DHB employees in a variety of unions, etc, contracts like cleaning and a range of NGOs delivering services of one sort or another. Accessing this information is extremely difficult, often impossible, for me even as a Board member and the tight control of information and lack of transparency are some of the greatest concerns to me.

• There is an anticipated deficit this year of around $10 million which is thought to be an optimistic estimate. Deficits are bad in a number of ways – they cause restrictions and cuts (a word that is disapproved of in the system) and penalties from government. So, the better your books the better it is for you financially too in the form of financial benefits. There are financial penalties for not having the accounts in order.

• There is going to be an increasing level of public education regarding looking after your health because getting it fixed will not be an option in many cases. I have been assured that the money that funds these education programmes comes from outside the pot, in other words, directly from the Ministry. I had been concerned that money being spent ranting on about smoking etc and funding salaries for a lot of education deliverers could be spent on fixing people who needed fixing but evidently this is not so. It comes from a different stream, I am told. I still have difficulty getting it totally clear about the incredibly complex funding model. It is like a tangled ball of string it seems to me!

• Re financials: I have followed up concerns about the source and level of interest paid for the CDHB loan arrangements. The older source of funding (direct from Reserve Bank) went out for everyone many years ago and the best rates available are sourced. NZ interest rates are high. There are advantages for early payments on loans and managing the financials is the Number 1 thing in the CDHB and one that has had other accountants/businessmen being brought in as consultants to the organisation. This is an added expense in itself.

A very short term attendee of HCH voiced disapproval that I haven’t, very early on, made a huge scene and walked out, resigning from the Board. I have considered this point and I have failed to see what would be achieved by it other than smirks, nods and a Chairman appointee. It certainly would not improve the health system one whit. Of course, I might get my name in the paper for a day or two. All the effort of drumming up confidence and votes was meant to lead to a responsible performance by whoever was elected, I had thought. Certainly, that has been the way I have endeavoured to conduct myself.

It has not been smooth sailing and there have been a number of rugged interactions and ongoing frustrations but it is my style to engage as a Board member with integrity and purpose who will not disrupt proceedings simply to gain personal notice and score short-lived points. Even so, I still acquired a reputation for one or two of the fiercer exchanges at the beginning.

In sombre moments, I have wondered if we Board members achieve anything different to what management would be doing in any case. But I know the answer to some extent. Yes, we do make a difference – just how big a difference is impossible to gauge. I am aware of some different actions that have occurred even as a result of my own queries and comments.

A considerable amount of work goes on outside the public meetings.

The dramatic level of change that is hoped for by many could only be achieved by a dictatorship, I tend to think. This government is certainly not going far enough but the alternative might be a whole lot worse. The new CEO, Gordon Davies, says that the last 3 – 4 years has seen the greatest amount of money going into health that there has ever been. So why are there so many disappointed people not getting procedures? Free hearing aids and a wider range of operations (e.g. varicose veins) that used to be done are no longer done – why, given all this money? A principal reason is the huge amount of salaries and the public always want to say ‘pay more for the lovely nurses, hard working doctors,’ etc. ‘Get rid of the managers.’

My response is that while the salaries of managers should be realistic, we do need managers. The nurses, in my view, are very well paid. Junior doctors who seem to be paid around $70,000.00 p.a. are, in fact, paid around $120,000.00 by the time you count all the add-ons of their contracts. True, they work longer than 40 hrs per week but not as long as they used to. They often offer themselves up for additional, higher paid, hours on the side. At what point do we say, yes, there is a world-wide shortage of health professionals, yes, you could get better money overseas. However, this is where there is a need by patients and would-be patients. Where is your commitment to health itself?

This year the increase of funding from Ministry is down to 2.93% and it goes down next year and further down the year after that. Where is the money coming from for increases in salaries? It cannot go beyond this. More money paid out in salaries/fees means fewer services/procedures for people, that’s what.

Many HCH people might have been under the impression that having an HCH person on the Board would achieve a desirable input regarding industrial issues. However, this falls into the category of management and not governance. As a Board member, I am responsible for one employee only, the Chief Executive, and for directing, at a high level, the trends and general way to go, not for specific ways of working or decisions that have been delegated to the Chief Executive. That is beyond the power and control of one Board member.

Heather Carter, 31 March 2006