GUEST BLOG: Ian Powell – Planned care taskforce report: something to weep over?

On 25 October Te Whatu Ora (Health New Zealand) released the report of its taskforce established to devise a plan to clear a backlog of patients waiting months longer than they should for treatment.

Establishing the taskforce was in response to both continual media exposure of tens of thousands of people waiting too long for planned (non-urgent or ‘elective’ surgery) and health professionals publicly expressing their serious anxiety over this crisis.

Laced with political spin

The report is devalued by being laced  with political spin which misleadingly promotes the government’s alleged opportunities arising out of its misnamed ‘health reforms’. It would have read much better if this lacing had been omitted and the report simply focussed on its recommendations and the justification for them.

It would have also read better if it had not downplayed the importance of the biggest cause of the planned care patient backlog; severe workforce shortages which were inherited from the previous National led government and then steadfastly ignored by its Labour led successor.

The report is titled Planned Care Taskforce: Reset and Restore Planned care taskforce report. Wisely the report is not just about wait times for surgery; it is also about the wait times for the even more important diagnosis. If the radiological or pathology diagnosis is not on the mark, the best surgeons in Aotearoa New Zealand will have the poorest surgical outcomes.

The report makes 101 recommendations, not to be confused with the 101 dalmatians. They are too many recommendations to cover in this blog. They include giving general practitioners more authority to deal with patients without the need for a hospital specialist, moving patients between regions, and more efficient use of surgical theatres.

Wider context of recommendations is the issue

But the issue is not the recommendations, which are generally sensible although there is a hint of privatisation. Instead the issues are the context in which they are located and the lack of the wherewithal (workforce) to deliver on them.

A day after the report was released I received an email from an experienced and respected former district health board chief executive who, with a heavy heart, observed:

I almost wept at the 101 recommendations announced yesterday on how to deal with the backlog in healthcare. I could have pulled off the shelf a similar report from 25 years ago and mistaken it. The health system is bereaved of leadership and those that understand what actually needs to happen. NZ health is going back so quickly and all of yesterday’s thinking being brought out and packaged as a solution and the brave new world.

Observations from some other former chief executives in a safer position to share their concerns have been similar in their sentiments. In all cases they have a wealth of experience and wisdom to draw upon in making this assessment. I agree with them.

Essentially the taskforce has brought together a number of ideas and initiatives that are in various stages of development (some embryonic at best). There is nothing wrong with this. In fact, it is commendable.

However, this should be seen in the context of the current state of our health system leadership. It  is trying to put in place and get up and running the new highly centralised structures that the well-remunerated business consultant led transition unit was supposed to do.

Instead there is now a high probability that little will come out of the report over and above those ideas and initiatives that might have come into fruition regardless of the restructuring. In fact, the distraction caused by this politically driven restructuring is likely to have delayed progress on several.

The report is not an action plan despite the political hype implying it was. Taskforce chair Dr Andrew Connolly can’t give a timeframe to clear the backlog of delayed surgery (including diagnosis). To be effective it needed an action plan but, for reasons well beyond the control of Connolly and his taskforce, this was never going to be achievable.

Andrew Connolly: excellent choice as planned care taskforce chair despite recommendations being aspirational

There are very few medical specialists in our public health system who are as, or more highly, regarded in the health system than Connolly. He had earned this respect in part through his effectiveness as both a leader of general surgery in Middlemore Hospital and former Chair of the Medical Council.

Connolly brought together the invaluable and unique combination of values, intellect, compassion and practicality. The rest of the taskforce also comprised able and considered people with healthcare  experience.

The best defence of the taskforce’s report comes from Connolly in a thoughtful interview with Radio New Zealand’s Checkpoint programme on 26 October: Clearest defence of taskforce’s report.

Masterclass interview

But inevitably, through no fault of the taskforce, the best that could be expected was that the report’s recommendations would be aspirational. This was made explicit in a powerful interview on 26 October with the President of the Association of General Surgeons Dr Vanessa Blair on Radio New Zealand’s Morning Report programme.

It is a masterclass interview condemning the recommendations are too vague to be a plan and fail to address the core reasons behind tens of thousands of people waiting for non-urgent surgery: Masterclass interview on taskforce’s recommendations  . This is a must listen to interview. It is a masterclass of precision, insightfulness, expertise and compassion.

 

101 dalmatians

So what makes the Taskforce’s recommendations aspirational at best. The prime reason is our severe workforce shortages in the health system reinforced by increasing acute and chronic illness demands on primary and hospital care caused by external social determinants of health such as poverty.

These shortages are across all health professional occupational groups. Only the workforce at the right capacity level can ensure effective addressing of the surgical backlog that led to the formation of the taskforce including implementation of its recommendations.

Unfortunately the response of the government to these severe workforce shortages has been one of neglect while its attempts to control social determinants of health have been inadequate to say the least. So what makes the reference to 101 dalmatians relevant? Not much at all, but!

101 dalmatians is a 1961 Disney animated children comedy base on a novel published five years earlier. A litter of dalmatians was kidnapped by the evil Cruella who wanted convert them into fur coast. A successful rescue of the litter puppies also led to the rescue of another 84 dalmatians making the total save 101.

While there is no Cruella involved the film made  children weep while the in the taskforce recommendations made experienced respected former district health board chief executives weep (almost at least).

Ian Powell was Executive Director of the Association of Salaried Medical Specialists, the professional union representing senior doctors and dentists in New Zealand, for over 30 years, until December 2019. He is now a health systems, labour market, and political commentator living in the small river estuary community of Otaihanga (the place by the tide). First published at Otaihanga Second Opinion