Tip of the Iceberg

By Jim McVeagh 17/11/2009

Continuing on from yesterday’s post on PHO finances, I see that the Herald is running a follow up article suggesting that the wasted money in health is the “tip of the iceberg”. Maybe. But I suspect global health warming is melting it away.

There is no doubt that there is excessive bureaucracy in the PHOs. Some of the delay in funding getting out into the community is certainly caused by administrative staff messing about with “processes” for months before the service is started. However, this is should be once off overhead, unless the DHB changes the rules the following year, which is distressingly common. Coupled with the DHB managers producing their own set of “processes”, it is a bit of a miracle that we see anything of the more specialised services (the simple GMS funding, and the like, run smoothly).

There is no doubt in my mind that 21 DHBs and 80 PHOs is ridiculous overkill for a small country like New Zealand. I suspect DHBs probably need to number no more than 9 or 10 and PHOs no more than 3 times that number, possibly less. Having said that, I do not think there are vast sums of money being wasted in that duplication. It is much more likely that money is being wasted by provision of services that achieve nothing of value for patients, by poorly designed incentives that beg for over-provision of services, by a culture of blame that makes frontline staff over-treat and over-investigate patients and by a hovering bureaucracy always ready to add yet another meaningless series of tasks to a simple procedure in an effort to close off a potential error unlikely to ever be repeated.

In the meantime, the PHOs are not the main wasters of funds. Former Hawke’s Bay District Health Board chairman Kevin Atkinson pontificates:

“Every health board in the country should be demanding that all community providers make a statutory declaration every year on June 30 of their unspent money and the time frame for spending it.

I’m willing to bet that Atkinson knows as well as I do that the DHBs will not ask this. For the very obvious reason that the answer will make them look very bad indeed. Just to really set the cat amongst the pigeons, Tony Ryall should insist on it. It should be a very entertaining fight.

I’ll bring the popcorn…


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