On Wednesday 22nd August UCAN made the following presentation to the CCDHB Governance Board.
Good afternoon. I will speak to the item about the ‘Citizens’ Health Council’.
The UCAN network strongly supports the moves the Board is making to draw on the knowledge and concerns of the residents of the District.
We also know from experience that it is not easy to facilitate productive public discussion in this political environment.
As most Board members know we have contributed to the public discussion of Health by drafting a Health Charter.
The Charter has been endorsed by a majority of the members of this Board, a dozen well known organisations and three political parties.
We produced the Charter because the equity of primary health provision – I mean ‘primary health’ defined broadly – was being undermined in the Capital and Coast District.
We noticed that the changes in Capital and Coast planning and funding were favouring people with the money, knowledge and day to day capabilities to manage their access to health services.
We were particularly concerned as community and union health services suffered a series of cuts and restructurings that changed the nature of primary health care.
For example, the disappearance of integrated, locality-based models for primary health such as SECPHO.
We doubt that the efficiencies being driven by the national consortium of General Practices as ‘Health Care Home’ are designed for or by high needs populations.
Given these kinds of national strategies, we also note that the logic of your funding arrangements seems to encourage the Board to prioritise the needs of your predominantly low NZ Dep populations.
There are deprived populations in this District, perhaps not as geographically concentrated as in other Districts.
Our other principle concern is provision for group living and day time activity for people with enduring mental illness.
We regard the events that led to the closure of Mahora House has a scandal that has not been addressed properly. A year has past since the Board received the Mellsop report.
However we acknowledge and support preparatory work done by this Board to consider improvements across the system for people with mental illness.
We suggest that the two issues I’ve raised – primary health care for high needs populations and residential and day provision for people with mental illness – should be early items on the agenda of the Citizens’ Health Council.
We also suggest that you call for nominations to the Council so that those who cope with the situations I have described have an opportunity to influence and validate the selection process.
A nomination process would also increase the likelihood of forming a genuinely diverse and creative Council.
Objectives of DHBs
Every DHB has the following objectives:
(a) to improve, promote, and protect the health of people and communities:
(b) to promote the integration of health services, especially primary and secondary health services:
(ba) to seek the optimum arrangement for the most effective and efficient delivery of health services in order to meet local, regional, and national needs:
(c) to promote effective care or support for those in need of personal health services or disability support services:
(d) to promote the inclusion and participation in society and independence of people with disabilities:
(e) to reduce health disparities by improving health outcomes for Maori and other population groups:
(f) to reduce, with a view to eliminating, health outcome disparities between various population groups within New Zealand by developing and implementing, in consultation with the groups concerned, services and programmes designed to raise their health outcomes to those of other New Zealanders:
(g) to exhibit a sense of social responsibility by having regard to the interests of the people to whom it provides, or for whom it arranges the provision of, services:
(h) to foster community participation in health improvement, and in planning for the provision of services and for significant changes to the provision of services:
(i) to uphold the ethical and quality standards commonly expected of providers of services and of public sector organisations:
(j) to exhibit a sense of environmental responsibility by having regard to the environmental implications of its operations:
(k) to be a good employer in accordance with section 118 of the Crown Entities Act 2004.
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”.
News from United Community Action Newtown
Members of the south Wellington community and supporters will be taking to the streets to protest against funding cuts affecting vital primary health services such as the Newtown Union Health Service (NUHS), as the CCDHB attempt to make $20 million of savings this year.
A new community group, United Community Action Newtown (UCAN), has been established to oppose the funding cuts and has organised the protest outside Wellington Hospital at 8:45am on Friday.
UCAN Coordinator Debbie Leyland says Newtown Union Health Service, which works with some of the most vulnerable people in the region, will lose $274,000 this year and expects to face more significant cuts in the year ahead.
“The DHB has indicated the 7.9% funding reduction to NUHS is required to help the DHB save $20 million this year. It has been indicated that the DHB needs to save an additional $20 million over the next two years which will have a serious impact on primary health care.”.
Leyland says the cuts will have serious impacts on patients who have no other option but to access low-cost primary health care, such as NUHS.
“Newtown Union Health is a low cost primary health service that provides vital services to some of the most vulnerable people in Wellington. The funding cuts are dire for the service. Services such as the diabetes program are likely to be cut. There are nurses and doctors volunteering to work for free to keep services going. Wellington Hospital’s A&E will become increasingly cluttered and there will be less ability for accurate assessment of A&E patients due to the extra pressure.”
Leyland says the Government is ultimately responsible for the cuts, and says Health Minister Tony Ryall has refused to meet with community representatives.
“The Government is using a sharp razor to cut services that are vital to the lives of many vulnerable people. We would like to discuss the implications of these cuts with the Minister of Health Tony Ryall so he understands the impacts. Minister Ryall’s office is refusing to meet with us and has told us that he does not meet with members of the community. This shows he is deeply out of touch”.
Leyland believes the cut backs are a poor financial decision and will cost taxpayers money.
“Several dollars are saved in other parts of the health system for every one dollar put into primary health care. These cuts will cost tax payers millions in the long run. The Government should be putting a fence at the top of the cliff, not simply relying on an ambulance at the bottom.” Concludes Leyland.
UCAN has also launched a petition calling for the reinstatement of the funding.
The protest will be taking place from 8:45am on Friday 10th August outside Wellington Hospital, near the A&E department.