Capital and Coast District Health Board
This text is from a speech presented by Professor Don Matheson at the launch of the 2016 UCAN Health Charter to the prospective Capital and Coast District Health Board (CCDHB) Board candidates in the 2016 election cycle.
An open letter to DHB Board members.
This letter comes from a network called UCAN that is supporting action being taken to ensure everyone in New Zealand enjoys the right to health.
One area that Boards can make a difference is Primary Care.
We recommend you eliminate access inequalities (increase availability, acceptability, and decrease price barriers) to primary health care services in your DHB area.
This will require differential investment to promote equity of access, by strengthening the primary care providers whose focus is on the provision of care and improved access for people on low incomes, Māori, Pacific, refugees and those with chronic illnesses, including mental illness. These providers may be mainstream general practices, Maori, NGO, or publicly provided services.
In strengthening primary care provision in the Board’s area, support models of care that are responsive to and respectful of the diversity of the Board’s community. One size does not fit all, and a single organisation outside of the public sector, monopolising primary health care provision in the Board’s area is to be avoided.
The DHB can fund this by stopping the current leakage and underspend that for a number of years has been shifting the Board’s resources from the community and primary care to the Board’s provider arm and the hospital. See this report for the situation in your Board. (Analysis of District Health Board Performance to 30 June 2015, Published June 2016, The Treasury, New Zealand Government)
In addition, we recommend you act collectively with other Boards and the Minster to address the national funding mechanism (base capitation formula, Very Low Cost Access, Services to Improve Access) so practices have money available to subsidise fees for patients who currently are struggling to access services. The current capitation formula is not adjusted to meet the high needs found in deprived areas, those on low incomes irrespective of where they live, or amongst Maori and Pacific populations.
United Community Action Network (UCAN)
The Devastating Effects of Health Care Cuts
“Two tragic events in Wellington’s southern suburbs of Newtown and Kilbirnie calls attention to the devastating consequences of inadequate health funding, including the ongoing health funding cuts, for mental health consumers”, says spokesperson, Debbie Leyland, from the Wellington based health advocacy group, United Community Action Network (UCAN).
“The recent death in the Kilbirnie supported accommodation facility, Mahora House, highlights the dangers caused by continual cuts to health-based funding from Capital and Coast District Health Board (CCDHB) to community based health services” Leyland states.
Mahora House was established in 1985 to support people who were being ‘deinstitutionalised’ from long-term mental health facilities and moving into community-based settings. In 2013 CCDHB 2013 withdrew funding from Mahora House. In March 2016 a resident at Mahora house was fatally assaulted by another resident.
This event follows a similarly tragic event in 2009 at Te Menenga Pai, otherwise known as Mansfield House. The murder of one resident and conviction and imprisonment of another was a traumatic experience for residents, staff, friends and whanau. The Coroner’s investigation found that Mansfield House was chronically short staffed and frequently had an occupancy rate beyond capacity. The report was critical of the role of the CCDHB in its support of a facility with such high need. The Coroner stated that if the controlling health authority, in this case CCDHB, “devolves its responsibilities” to another service then it must continue to ensure ongoing audits ensure that care is delivered appropriately.
“Will an investigation into the recent tragedy at Mahora House present similar findings from the events of 2009? Did the DHB heed the warnings from the Coroner’s report?”, asks Leyland. “The CCDHB has a mandated role to improve, promote, and protect the health of people and communities and to reduce health disparities”
In 2010 the Minister of Health instructed the CCDHB to commence a policy of clawing back savings of $60 million in a three year period. The CCDHB CEO Ken Whelan resigned stating then that he could not “cut costs any further without undermining patient care”. Many of these ‘savings’ came from restructuring funding streams to community based services, ultimately forcing many to merge, reduce the services offered, or to close. Some of the service losses in the Wellington southern suburbs have been advocacy and Midwifery services and drop-in and activity centres.
UCAN calls on the CCDHB to halt all plans to reduce funding to any community-mental health focused services and for an investigation to assess the impacts of the loss of services that have supported the health and well-being of some of the most marginalised and vulnerable within our communities. Are these on-going cuts making inequalities worse? UCAN feels the answer is yes.
“Tragedies hit harder in small communities” says Leyland, “It’s no longer health, it’s Hell”.