A letter for all District Health Board Candidates

By John Pickering 30/09/2013

Dear District Health Board Candidates

Soon I and thousands like me will cast our votes to choose our District Health Boards.  Given the huge budgets of DHBs and the huge potential to influence health outcomes I want more information from you than a couple of paragraphs I received with the voting packs.  Below are two questions I think are important.  As this is an open letter on a blog site, I invite others to submit their questions too.  I also invite you, the candidates, to state your name, the DHB you are running for and your response to my or other posted questions (ie not just the blurb from your pamphlets).

My questions:

1. What single health intervention do you want to see implemented and what evidence do you have that it would be efficacious?

2. What plans have you for increasing patient participation in research?


Dr John Pickering

Tagged: budget, District Health Board, evidence based policy, health, Research, Vote

0 Responses to “A letter for all District Health Board Candidates”

  • Anna Crighton – standing for re-election to the Canterbury District Health Board
    There are many areas I consider important for health intervention and one of these is the over consumption and abuse of alcohol. I believe the same target figures should be set by the Ministry for Health as they are for the stop smoking campaign.
    Millions of health dollars are used every year in reaction to health problems from alcohol abuse, and this includes the overloading of the emergency department at weekends and the effect on hospital beds for the more serious cases. Heart, blood pressure, brain disorders, diabetes, kidney, bladder, mental health and other problems from alcohol abuse are using vital health dollars that could be used for other health purposes, including research. It will take time but if we can succeed in alleviating this problem then our ‘healthy Christchurch’ will benefit in many and diverse ways.

  • Aaron Keown -standing for re election to the Canterbury District Health Board.
    I have been a strong advocate for cycling in Chch and I was able to get the $68m cycleway network into the latest budget. The health benefits of people using active transport are a clear intervention into the obesity epidemic. I am currently working closely with CDHB staff to establish a ‘bike fund’ for the promotion of cycling as health will be the real winner as we make this societal change.
    I don’t have any plans personally around increasing patient participation in research but I have been pivotal in bringing together various groups who are planning the establishment of the health precinct in the rebuild of Chch.
    I will also take this opportunity to say that in the next term I would like us as a society to have an open debate around increasing the number of organ donors. I would like to start the debate by asking the question… How would the system look if the default position was everybody was an organ donor and those who wanted to could opt out? This should also include all children, parents need to discuss this when they have healthy children so they have a position if they are ever faced with their child being in the position to be a donor.

  • A twitter message from Paul McMahon – standing for election to the Canterbury District Health Board
    ‏@McMahon4SH 5h I’ll get back to u later in the day 🙂
    Briefly, though, increased focus on healthy housing. I don’t know how to increase participation in research – do u hav any ideas?

  • Response from Murray Clarke – standing for election to the Canterbury District Health Board:
    Hi John
    As first time candidate I cannot answer the first question accurately as I do not know how the Board arrived at its present decisions nor can I comment on the quality of the information supplied to Board members that encouraged them to make those decisions

    However your question (2) is area that I have been working on- as you know my background is Facilities and planning and it has been always my contention that Research programs and interaction with public cannot easily occurred unless suitable easily accessible facilities are available
    You will note example of this opposite your office
    To this end I have been attending all of the Health Hub planning meetings and pushing for space to allow students and Researchers to be able to congregate in each hub and thus be able to interact with public
    I am pleased to tell you that the tentative plans for the North Canterbury Hub allow space for training rooms and offices for itinerant visitors- my vision is that this should be replicated in all health hubs

  • Note/Disclaimer Mr Murray Clarke and I have the same employer and work in the same building, hence the comment about my “office”

  • Response from Robin Kilworth – standing for election to the Canterbury District Health Board
    Hello John,

    The single health intervention which I want to see
    implemented is a free screening programme for bowel cancer
    in the male population between 50 – 70 years in Canterbury.
    I believe there is statistical evidence for this but I can’t
    quote it. I am aware informally from medical practitioners
    and specialists that the instance in Canterbury is high. My
    husband is a survivor of bowel cancer but I am aware of a
    significant number who are not. Early diagnosis and
    intervention is important – screening would provide this.

    I believe that the opportunity exists to invite a group of
    bowel cancer survivors and patients as well as the male
    population in the target group to be involved through
    whatever mechanism will be the most reliable. Advertising
    through existing channels or through GPs and specialists for
    interested participants would increase the likelihood of
    voluntary participation.

    Thank you for the opportunity to answer your questions


    Robin Kilworth

  • John Noordanus – Standing for 1st time election for Canterbury District Health Board.

    Thank you for your two important questions. I have a raft of ideas and initiatives that i would like to see implemented but also understand the overwhelming competing demands of what needs to be prioritised, and what can be strategically considered with the balanced support of my prospective Board colleagues and the demand of community expectation.

    However one initiative I would like to see which I have participated in successfully in Queensland is the National Bowelscan program that is annually hosted by Rotary International in partnership with the hospital system. Catching Cancer before it catches you is not an unreasonable health cry from our community!
    If we were able to develop this initiative in partnership with Business and Community organisations, i believe we are contributing to working towards reducing what is the 2nd highest cause of cancer death in NZ (Cancer Council NZ Stats). I understand that Pilots are sporadically running – some with good outcomes and some with trends that can be mitigated. Our need to enhance public awareness of the need for bowel cancer screening, promote and coordinate an annual program (for the most at risk demographics) and emphasise the importance of bowel cancer screening for men and women. Our community is increasingly lacking in exercise and obesity is on the rise so this cancer will continue to be a blight on people’s lives in years to come. Any pilot comes with the potential to develop good research and capture information that can potentially go a long way in promoting early intervention strategies for our nationhood.

    In terms of promoting patient participation in research John – I do not have a plan. What I am interested in doing however as a result of reflecting on your question is guage what benefits we have had in recent years in regards to any participation that has transpired? I support good research and hope that funding from any savings or initiatives that actually is addressing the very reason people are clogging our hospital system and dollars is channelled into research initiatives. We have technology, and bright people wanting to find ways to contribute to improving people’s lives through research and this in principle needs to be encouraged where possible.

  • Response from Andrew Dickerson – standing for election to the Canterbury Health Board
    Thank you for your e mail. My responses follow:
    1. What single health intervention do you want to see implemented and what evidence do you have that it would be efficacious?
    Bowel Cancer Screening

    We have the highest rate of bowel cancer in the world. There is well documented international evidence that a targeted bowel cancer screening programme can both:

    a) reduce the incidence of bowel cancer (by the identification and removal of polyps, reducing the risk of bowel cancer developing)


    b) increase the survival rate of patients with bowel cancer (by early detection).

    Canterbury was one of two District Health Boards short-listed for a pilot bowel cancer screening programme but this pilot was awarded to a North Island DHB. This pilot is already showing promising results.

    But I wonder about the need for a pilot when there is strong evidence from overseas that targeted bowel cancer screening is a very effective health intervention.

    Bowel cancer screening programmes already exist in Australia, the United Kingdom, South Korea, Japan, Israel and most EEC countries.

    Commenting on a UK bowel cancer screening programme, the Chief Executive of ‘Cancer Research UK’ was quoted as saying (‘Guardian’, 28 April 2010): “CRUK doesn’t often use the word “breakthrough”, but this is one of those rare occasions. It is extremely rare to see the results of a clinical trial which are quite as compelling as this one.”

    Alcohol Reform

    I support all the recommendations from the NZ Law Commission on the need for comprehensive alcohol reform. The Law Commission’s report refers to compelling international research supporting comprehensive alcohol reform.

    It is my personal view that the legislation passed by Parliament last year was timid. It will do little to address alcohol related harm in our community. There is very compelling evidence that comprehensive alcohol reform would significantly reduce the alcohol related harm we see every day in the health sector. But it will also reduce crime, given the link between alcohol and violent crime, sexual assault, domestic violence, child abuse – and, of course, violent assaults on healthcare workers.

    If the Government (and indeed Parliament) was serious about cutting unnecessary public expenditure and reducing violent crime it would have comprehensive alcohol reform at the top of its agenda.

    See my comments at the following link:


    2. What plans have you for increasing patient participation in research?

    I think the DHB can help promote and encourage participation in approved research studies through its communication channels and through its very large workforce.

    I also support a working environment that supports and encourages research and co-operative relationships between the DHB and medical researchers, the School of Medicine and clinical research units.

    Kind regards


    Andrew Dickerson
    Elected Board Member, Canterbury District Health Board

  • Response from Andrew McCombie – standing for election for the Canterbury District Health Board
    Hello John,

    Thank you for your email. Brief answers are below:

    1. What single health intervention do you want to see implemented and what evidence do you have that it would be efficacious?

    I would push for computerized interventions and the wider implementation of “e-health” to be brought in to the CDHB. I have anecdotal evidence among inflammatory bowel disease patients from my own research thus far (with objective evidence to follow) and there is more quantitative and objective evidence in irritable bowel syndrome, tinnitus, and chronic pain (which incidentally have psychological components to them).

    2. What plans have you for increasing patient participation in research?

    I am a PhD student at the University of Otago and have had good response rates to my research projects (which are admittedly low risk). Inflammatory bowel disease patients in Christchurch have traditionally been very compliant with studies. If you are more precise about the kind of research you would like increased rates of participation in I could answer more specifically. Perhaps patients could be invited into joining electronic patient databases wherein they are contacted if future research comes up?

    Thank you,

    Andrew McCombie

  • Response from David Morrell – standing for election to the Canterbury District Health Board

    Hi John
    Sorry about the delay – been in Wellington.

    I want to take this another way. The most useful contribution I believe the incoming board can make to health effectiveness is to pursue
    a) the completion of the projected new builds at Burwood and Christchurch Hospitals as planned (!) in conjunction with
    b) further integration of primary and secondary/tertiary care allied with increasingly sophisticated use of the advanced resources of our hospital system.
    In both regards I believe the board has recently been heading in about the right direction. My UK postgrad (1977!) convinced me of this.
    I do agree with all Anna has said about alcohol consumption but am aware much of the answer lies largely in the political and community arenas. However I don’t consider board members are there to pursue their own particular medical hobby horses!
    We have excellent clinicians and researchers to bring forward and test proposals.
    I consider the Consumer Council is a start in achieving more patient/research involvement and don’t favour financial inducement but do consider that a budget allowing much higher profile advertising around particular research projects could work.