| One of the problems New Zealand has is our tendency to be nice . This shows itself in many ways. We have a single finder, state owned health system… that is controlled by a series of centrally driven contracts to local and regional district boards… that have centrally appointed members (in addition to those elected at local body elections.
The board is in an invidious position. They have all the responsibility but no ability to change contracts. They are a supplier. This leads to comments like this:
Chief operating officer (Otago) Vivian Blake reported to the meeting on the organisation-wide systems approach being taken to address the length of time patients are spending in Dunedin Hospital’s emergency department under the banner “6 Hours It Matters!”.
It was considered that improvements would result, but it was not realistic to believe the board could achieve the national target by June 30, she said.
The target requires 95% of patients to be seen treated and discharged or transferred to a ward within six hours of their arrival at the department.
I am not employwed by the health board — my main contract is with the university. Macdoctor — who works in Accident and Medical Systems — makes many comments on the system.
Does anyone really think that the current public health system funds anything more than “bargain basement” treatment? (Unless by the phrase “bargain basement” you really mean “inadequate”; because that is a whole different ball of wax). There is and will always be a limited amount of money in state-provided health care. We will always be making decisions about rationing health resources. Allowing private patients into public facilities is not going to change this in any way. It is even possible that the extra funds may provide better health care for state patients.
The Two-Tier system is a present day reality. Instead of having angst about it, we should be trying to make it work for us.
So why use 6 houtrs? Well it came from the UK. The idea is that this is not only a measure of ED but of the ability of the bospital to efficeintly mjove people along. It comes from the idea that a hospital is like a factory, and management is management. However, this is not quite true. Hospitals deal with people, and people are ornery. They get annoyed, leave, complain, and (given that GPs deal with lots of acute injuries) generally have severe and complicated issues to require admission.
And there are ways of gaming the system. You can set up acute medical wards — right next to ED. You can sent the non complex to the friendly after hours GP service. And.. .all these tricks are used. The problem is that emergencies are just that — and the issue is how many of the most complex get good outcomes over the next 24 hours. Not how long a person is waiting to have a simple fracture fixed. All doctors know this… but managers and politicians are not prepared to have this conversation.
