18 Aug 2016

'Evolution, not revolution' to turnaround Southern DHB

9:32 am on 18 August 2016

The country's most troubled district health board says it will turnaround its fortunes by improving its services, not cutting them.

Dunedin Hospital.

Dunedin Hospital. Photo: RNZ

The Southern DHB has been plagued with negative publicity, most recently about the out-sourcing of its hospital food.

Its board was sacked last year and replaced with commissioners after its financial deficits blew out more than $30 million.

The lead commissioner, Kathy Grant, was installed with a hiss and a roar, and a clear directive to get the finances back in the black.

Southern DHB lead commissioner Kathy Grant.

Southern DHB lead commissioner Kathy Grant. Photo: RNZ / Ian Telfer

One year on, Ms Grant told RNZ she has agreed to a plan with the Ministry of Health to eliminate the $33m deficit by the 2019-20 financial year.

And she has agreed a figure for this financial year that is a significant step in that direction.

Although she will not say what that is yet, she said she is now confident it can be done without any big service cuts.

"We could balance the books very quickly by kind of slashing, burning, cutting, burning, whatever, but that is not the approach we are taking."

Ms Grant said any savings from that would be unlikely to be sustained, so the commissioners are looking at new ways to deliver services which improve them and save money at the same time.

Her team is already succeeding by getting staff united through a new culture of openness and communication, and a series of clever projects, Ms Grant said.

And the DHB is employing pharmacists to bring down the use of pharmaceuticals among the elderly, investing in better IT systems to reduce patient transport, and creating tele-medicine systems so clinics can be run in remote areas without travel.

She says there is more to come, and the turnaround will come from evolution, not a revolution.

The pro-vice chancellor of health sciences at Otago University, Peter Crampton, said Southern DHB should be a national leader because of the special environment of the strong university, polytechnic and community organisations it is tied to.

Pro-Vice Chancellor of Health Sciences at Otago University Peter Crampton.

Peter Crampton Photo: SUPPLIED / University of Otago

But Professor Crampton said the DHB lost its way because it was preoccupied with its deficit, and has been weak at articulating its future direction and implementing its strategy.

However, he said the DHB has now developed a very strong strategy document, the Southern Strategic Health Plan Te Piki Hauora, and that is what it needed to focus on.

Looming in the future is the near complete rebuild of Dunedin hospital, which needs decisions about which health services have to be delivered there, and which would be done better by, for example, shifting them out to community clinics.

It is early days, but the process has already led to fears the government might downgrade it in a way that hurts the university's medical school.

Both Professor Crampton and the commissioner Kathy Grant say they see nothing like that coming.

Robin Gauld, a health systems specialist at Otago University,

Robin Gauld, is a health systems specialist at Otago University. Photo: RNZ / Ian Telfer

Robin Gauld, a health systems specialist at Otago University, said the DHB is on the way up and was never as bad as was made out.

But Professor Gauld said the commissioners have a big challenge for next three years: first raising the confidence of the government, the DHB's own staff, and then the public.

"We have a public in this part of the world which are probably deeply sceptical, and deeply worried, and they like to rally around services because they fear there is something going on in Wellington"

Professor Gauld said he commissioners have done a pretty good job, but the Southern DHB is the most complex to run in the country because of its size and sparse population, and it could do with more support for all the good things it is doing.

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