Eight months ago I was privileged to be part of a delegation from the South Taranaki GPs to the Interim TDHB.  The two members of that Board who are on the current Board will remember that we were not very happy with the management plan to permanently close the Hawera Hospital HDU and have all acute admissions sent to Taranaki Base.  In fact we were particularly upset by the excuse given.

 

However I am not here to go over old issues, nor to get angry over new ones.  In fact we would like to thank the Taranaki District Health Board for undertaking a fairly thorough and moderately open consultation process and for their choice of Dr Dennis Pisk who proved to be a likeable lad with an ability to take on board the concerns of all stockholders and to come up with a workable compromise that would see the restoration of uncomplicated acute admissions to Hawera Hospital.  We would also like to thank the current Board for adopting his recommendations as the "preferred option" and I would like to personally thank you for tolerating my letters, submissions and e-mails which I hope you read.

 

As you are aware, there has been considerable concern by the South Taranaki GPs over the progressive reduction in services at Hawera Hospital over the last 20 years, starting with the King Report of 1982.  By 1994,  the centennial year of the hospital, all inpatient specialist Obstetric, Gynaecological and Surgical services had gone as had the children’s ward and we were left with an adult medical ward and a confusing array of managers!  The promised increase in day-case surgical procedures with reduced waiting times remains a pipe-dream.
 
When Dr Peter Lay retired, the remaining Physicians found themselves on a 1 in 2 roster, or alone when the other was on leave, with no locum or Base physician provided.  CME and peer review began to suffer, and so it was sensible for the physicians to accept employment elsewhere that gave more time off as well as better opportunities to follow their areas of interest and to keep up to date.

 

Rightly or wrongly, the South Taranaki GPs have believed that the TDHB management has been acting in such a way that encouraged this loss of physicians and their apparent lack of enthusiasm in looking for replacements seemed to confirm this.  The GPs in South Taranaki made strong recommendations to the Independent reviewer Dr Dennis Pisk to restore resident specialist physicians in Hawera but most of us now accept his interpretation that retaining them would be difficult unless there were a minimum of 3.5 FTE (three plus relief cover), and a MOSS position.

 

The Option Three concept of a team of Multi-skilled Medical Officers managing most acute admissions in a new hospital with support from specialists and close ties with GPs is exciting, and overseas experience tells us that it not only works, but is safer and cheaper than shipping everyone off to specialty units. [hold up Blayney submission document]

 

The success of Option Three is dependent on the concept of a core team of these Multi-skilled Medical Officers (or MMOs) being promoted and supported by the Board, its management and the community at large.  Crucial to attracting and retaining these Medical Officers will be the whole package, with assurance of excellent remuneration, an acceptable on-call roster with available cover for leave, on-going Continuing Medical Education (CME) and links to medical colleagues including daily specialist support, telemedicine links as well as regular educational interaction with GPs and ED staff with a move to integration as outlined in stage two.

 

However, the GPs are still very concerned that Option Three is likely to be "watered down" by some management convincing the Board that we can’t afford to support the Hawera MMO team with daily specialist visits or adequate cover or CME and peer review.  Basically, any penny pinching or over-working of doctors will lead to retention problems and even greater costs.

 

We are particularly concerned to hear and read that management is costing Stage 1 at $600,000 and the full package at $2 million per annum, and we are concerned that this may influence the Board to accept their watered down version.  This figure is clearly "over-the top".

 

When you think about it, the Board is really just replacing the two specialist physicians and a part-time MOSS with three and a half medical officers at a generous MOSS pay scale - and the more generous, the greater the attraction to come and to stay.  Dr Pisk is also asking current staff to do things differently.  So why do management tell us it will need all this extra money, other than to reduce the Board’s whole-hearted support?? 

 

Put another way, why would we need the Pisk recommendations at all if we had $2 million extra p.a. - we could offer 4 specialist physicians a salary at twice the going rate and three months sabbatical a year and have enough left over to employ 3 MOSS at a generous salary! 

 

Well, as the Board knows, I have analysed the cost breakdown and identified some major errors, omissions and found, shall I say, some extremely "creative accounting".  There will be less transfers, less helicopter flights, less stress on Base Physicians, and less need to defend yourself from Dr Blayney’s accusations!  If management was to offer MMOs what they allow for salaries, we wouldn’t even need to advertise!  As you know, the bottom line is that I could only justify an extra $303,000 per annum for the full implementation, not $2 million.  However, I'm not an accountant nor a manager so I’m not asking you to just believe me.........

 

According to Dr Dennis Pisk [in the middle of page 47 of his report], Stage One will cost about $300,000.  Stage Two is really just integrating with the Emergency Department and while Dr Pisk was not able to reveal the current cost of providing that service, he noted that the $600,000 for stage two would be offset by that undisclosed amount.  I suggest the Board should trust Dr Pisk. 

 

If the cost of running the new hospital with acute admissions is more than the historical spend of $7.9 million, I suggest you ask to see the books. 

 

In Conclusion, Option Three can work, but only if the Board wants it to and works with the community in a transparent way to achieve that goal.  Fortunately, there are signs that this is becoming the case -for example, I am very pleased to report that the new Recruitment and Retention Steering Committee now includes two GPs and a South Taranaki Health Group representative.  This committee met on Tuesday and was able to reach some consensus on targeting and attracting the sort of doctors the new hospital needs.  So I would like to end with another "thank you" to the Board for their support. 

 

Dr Keith Blayney