21 Aug 2020

Canterbury DHB woes: 'Somebody needs to come to their senses'

12:58 pm on 21 August 2020

A Christchurch doctor is calling on the Health Minister to intervene in the face of an exodus of senior managers, a huge deficit and fears of large cuts to staff and services in Canterbury.

Protesters gather outside of the Canterbury Health Board corporate office on 20 August.

Staff from Christchurch Hospital make their feelings clear outside the CDHB offices. Photo: RNZ / Katie Todd

Canterbury DHB is in the red to the tune of $180 million and its board and senior management can't agree about what should be done about it.

The Canterbury medical community's frustration with its health chiefs reached a boiling point yesterday, with a protest outside the board's offices, an open letter and two more resignations on the DHB's executive team, including nursing director Mary Gordon.

Chief of medicine at Christchurch Hospital David Smyth believes executives at the DHB have been under impossible levels of pressure over finances.

He told Morning Report that he wanted Health Minister Chris Hipkins to hear directly from staff like him what the possible impact of cuts could be: "I'd love him to come and talk to the clinical leaders and hear our concerns; listen to us and just reassure us how this flagship health system can continue."

Smyth said with at least $56 million needing to be cut from the annual budget, it was impossible to see how this could be done without cuts to services and staff.

"We think such a big cut will lead to reduction in services and reduced outcomes - not only for the people of Canterbury but for the whole of the South Island as well."

Smyth said senior managers are quitting because they have been under impossible pressure to achieve the budget cuts. The DHB has had to deal with the earthquakes, the mosque attacks and the Whakaari/White Island eruption and the legacy that had been built up was being dismantled.

The board chair, Sir John Hansen, has told The Press newspaper today that savings are possible without making cuts. Smyth said he and other clinical leaders would like to hear him explain how because they could not see it.

He said staff knew the DHB had to be fiscally prudent but the deficit in Canterbury was due to the earthquakes and the fact that the new Hagley building was being completed three years late. This has meant clinical services have been outsourced to private facilities with extra costs incurred.

"In fact, the DHB gave a heads-up to the Ministry [of Health] that if Hagley was to come in three years late this deficit was to be anticipated so it's not a surprise and in fact we provide very good care. We remain within our operating budget."

Inside the new Acute Services Building at Christchurch Hospital.

Part of the new Hagley building which is running three years behind deadline. Photo: RNZ / Katie Todd

He said the senior managers who had quit were being snapped up by other health bodies which was tragic for Canterbury.

"Somebody needs to come to their senses and see that it's not just the financial bottom line that's important - it's the delivery of health services and maybe cut Christchurch a little bit of slack given what they've been through over the last 10 years."

Smyth said the region was losing a lot of health talent who had navigated the region through tragedies and disasters and it was now in the midst of the pandemic.

"At least half the people admitted to Christchurch Hospital would still have to be in antiquated, very poorly designed facilities and we are not really that geared up to deal with many patients with Covid."

Board accused of ignoring values

Canterbury chief medical officer Sue Nightingale says she's decided to quit because of the constant divisive approach of the board members and the Crown Monitor she has to work with.

Nightingale told Nine to Noon that the transition from a cooperative approach to health care to a more adversarial strategy happened after the new board took charge.

"You'll be aware that culture permeates down. One of our main values is care and respect and we know that if boards don't live to the values, that problem with the culture will end up eventually permeating down to the people doing the job at the coalface, and that's something I find difficult to live with."

She said board members brought in an independent clinical adviser earlier this year - despite having three clinical leads on the executive management team who could have given them advice.

Seven executive members leaving within a few weeks was "a crisis for Canterbury". She had told the board that its adversarial approach to the senior management team had made it impossible for her to continue.

The DHB's finances were a revenue issue, not a financial management problem and that dated back to the earthquakes that began in 2010.

"The actual need to cut spending has not really been the point - it has been how that has gone about."

Canterbury DHB chief medical officer Dr Sue Nightingale and Director-General of Health Ashley Bloomfield who confirmed eight cases of Covid 19 at a press conference in Christchurch.

Sue Nightingale is one of seven senior managers leaving the Canterbury DHB. Photo: RNZ / Simon Rogers

She said the CDHB was a world leader in many areas but now there was a worry that some areas would be seen "as nice to have".

"I really think the Ministry [of Health] and the government should be worried. ...I totally get that they're in the middle of Covid... but we would feel a bit more reassured by a bit more attention."

There needed to be a culture change, she said.

RNZ has approached Hansen and the Crown monitor Lester Levy for comment.

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