Ministry’s bitter pills


Wellington wields big stick over DHB plans

An ominous new Ministry of Health report shows Queens­­town’s hospital is under threat, claims an action group calling for a service shakeup.

A previously unpublicised official document reveals Ministry of Health big-wigs getting stuck into Southland District Health Board over Lakes District Hospital.

Service cuts are signalled along with sell-offs, privatisation – and the end of long-term elderly care at LDH.

Mountain Scene showed the report to Maria Cole of the Wakatipu Health Trust, which has unsuccessfully pushed to bring LDH under local community control.

“LDH is under threat, there’s no question – and this is really confirmation,” Cole says.

“I think [the MoH] is looking at a range of strange models…[which] represent reduction in services as well as reduction in costs.”

In the report, the MoH tells SDHB it must “find an optimal model of care for [the Wakatipu]”.

Cole: “That means a model that costs the DHB less and therefore provides fewer services. [The report] might as well have been written by accountants.”

Another section of the report called “service configuration” sends shivers down her spine: “That’s of grave concern.”

Speaking of how LDH “poses unique challenges” to SDHB, the report adds: “A different model of care may improve sustainability at [LDH].”

Does “different model of care” mean cuts?

Cole: “Absolutely – it smacks of a reduced service, [it’s a] regressive step for Queenstown.

“Reconfiguration could mean scaling down the hospital and running some sort of clinic – that’s one potential model they’re looking at.”

There’s also a clear hint that LDH may reduce opening hours at its accident and emergency department.

“There is some evidence that [LDH and other SDHB hospitals] are performing primary acute care functions that could more appropriately be provided through [GPs],” says the report.

Patients could go to the privately-run Queenstown Medical Centre – open weekends and every night until 8pm – when the hospital A&E is closed, the MoH implies.

“[SDHB and the MoH would] perceive that as an option that would certainly reduce cost,” Cole adds.
As she points out, “[The MoH] is putting pressure on DHBs to address their deficits”.

Sure enough, in the report the MoH reminds SDHB that the health board has “delivered financial deficits in five of the previous seven years”.

 Scalpels out for elderly

Quenstown’s already-troubled elderly care faces an uncertain future.

“The direct provision of aged residential care is not within the DHB’s core business,” the Ministry of Health report says.

SDHB has just six elderly care beds at LDH – it’s long been under pressure to provide more beds as Queenstown has grown.

Many old-timers have been exiled from the Wakatipu because of the shortage of hospital-level care.
SDHB will still be obliged to fund elderly beds – but if it doesn’t want them at LDH, it’ll have to find a private provider who’ll be paid to run them for the DHB.

That leaves a question mark over whether those old folks’ beds will remain in the Wakatipu.

“[The fact] that that document states elderly care is not core business … is morally reprehensible,” Wakatipu Health Trust’s Maria Cole says.

The MoH is ordering SDHB to find an “optimal model of care” for the Wakatipu that includes primary, aged and private healthcare.

This “model” also needs to consider revenue available from insured overseas visitors, insured residents and residents who choose to pay for private healthcare.

We’ll all be bonny in Clyde

Dunstan Hospital is 86km down the road in Clyde but health officials could be eyeing
it up for Queenstowners.

The Ministry of Health wants a “regional” model of care for Lakes District Hospital and suggests SDHB taps into Otago DHB medical resources to serve Queenstown.

Instead of a two-hour drive to Invercargill, local patients might almost halve travel time to the 28-bed, community-run Dunstan Hospital.

“Southland DHB has the po­­­tential to leverage off Otago DHB’s clinical expertise and resources,” the MoH report says, adding part of LDH’s “unique setting” is its proximity to Dunstan.

SDHB should also consider “one-stop-shop models” to cut costly transfers to Invercargill.

But the Wakatipu Health Trust’s Maria Cole is worried this will reduce LDH’s capacity even further: “My fear is it means a scaled-down clinic [at LDH] with no more than holding beds in lieu of a public hospital.”
Compared with LDH, Dunstan has rehabilitation beds and double the outpatient clinics – but patients with serious conditions would still go to Invercargill, Dunedin or Christchurch hospitals, Cole says. “There are some opportunities for sharing of services for things that you wouldn’t duplicate for things at hospitals that are an hour apart … like sharing some outpatient specialists.

“The prospect of people being forced to drive for an hour through a difficult gorge at certain times of the year is a retro­­grade step. But it’s an expedient solution.”

The MoH talks of “gaps” in access to outpatient services in the Wakatipu due to staff shortages, while cooperation and communication between LDH and Southland Hos­­-pital over operational issues is “minimal”.
A region-wide service wouldn’t just be limited to ODHB facilities – it’s got to be cost-effective, so other South Island DHBs may go into the new regional brew.

Cole understands the “regional clinical services model” would be like a “road map” of health services for doctors to direct patients to.

Crunching old numbers

Wellington is way off on the Wakatipu’s population.

The Ministry of Health report – written last month – uses population figures from 2006 instead of the most recent June 2008 Statistics New Zealand data.

The MoH says the Wakatipu had 10,442 people in 2006 – but Statistics NZ estimates 16,760 for 2006 and 17,880 in June 2008.

The MoH funds DHBs through a population-based funding formula (PBFF) – with differing figures, it doesn’t bode well for Queenstown.

However: “The proposition that SDHB does not get its share of PBFF relative to other DHBs is not supported by analysis,” the report says.