I have worked in a variety of hospitals over the last 20 years. There has been increased money, and increased reporting to the Ministry of Health. This has led to an increase in the number of administrators…

The funding of most of secondary care and a fair bit of primary care comes from the government. They are the true customer, for they pay the bill. For example, the Southern DHB, which covers 300 000 people, has a budget of 113 million.

The current government did get the message. The number of targets has been decreased to five, against the protests of the last government, which was in love with preventive services. If you want to know why your GP wants you to be seen for a review of your Cardiovascular risk status annually and asks you to quit when you have never smoked… this is why.

The problem is that, as a country, we are almost broke. The reason we are not a basket case is that various nations that are further down the road to serfdom are even more bankrupt. I’m told that there need to be about 5% cuts in all services (and the Treasurer is quite grumpy the prison population is going up, which increases the spend. The Minister, quite sensibly, wants the money spent on the front line.

How can we help this? This list may be politically unsustainable but could help.

• Destroy the microsoft contract with the DHBs, negotiated by the ministry. The US Veteran’s Administration Health system is about the same size as NZ. They use OpenVista. As the source is open, and the interfaces are well documented., we can modify it. There is no point in reinventing the wheel.
• Move back office functionality well away from clinical care, preferably into recycled buildings. For example, Gore Hospital for the Southern DHB.
• Reduce Quality Control and forms committees — we do not need 23 versions of clinical notes. Senior Medical Officers are supposed to spend time in audit. A monthly audit meeting across the region looking at surgical complications, number of suicides, assaults on nurses would be of more benefit than report forms.
• Get the patients in on the act, particularly with chronic diseases. Open up grand rounds and journal clubs. Share information. Discuss priorities for further development.
• Demand that there is an evidence base behind practice. This does not necessarily mean people should mechanically follow the guidelines, but it does mean that interventions without evidence, such as psychodynamic psychotherapy, should stop. There are more modern, cheaper therapies that do work.
• Provide continuity of service, particularly for doctors-in-training. Senior Registrars should be advised as to what jobs will be available in about two to three years, and encouraged to get training experiences that allow them to move into that job. Nurses and allied health professionals need appropriate continuing education and an ability to work flexibly when they have small children (as well over half the health workforce is women, it does not make sense to not consider that at times they may want to have and raise children). It is cheaper to keep people than hire new ones.
• Move the DHB to direct funding. Vote health was 13 billion last year. Cut taxes, but allow the local DHB to raise local taxes. Thus, if Dunedin wants a gold plated service, they have to pay for it. However, this needs to be balanced with…
• Allowing patients to sue for punitive damages, if their health needs, which they have paid for, are not met.

Has this worked? Well, it used to. I have described a similar system (with the exception of the computers) to the one New Zealand had in 1930.