A healthy outlook
Preventing sudden infant deaths and ensuring children get an equal start in life are just some of the causes Nelson Marlborough’s chief medical officer is passionate about.
Dr Nick Baker first started working in Nelson as a community paediatrician more than 20 years ago. His role was focused on improving the health status of the entire community of children.
He now spends half the week in the paediatric ward, working on the front line and the other half in a strategic role as the health board’s chief medical officer.
He was drawn to paediatrics as it was overall an ‘‘optimistic speciality’’.
‘‘Our patients, even the smallest and the sickest, they generally get better.’’
From extremely premature babies, to dealing with infections, the management of child abuse and right up to challenging adolescents, paediatrics covered it all.
It also provided valuable experience dealing with stressed adults which helped in his chief medical officer role.
‘‘You are trying to communicate with a baby or a small child, but actually you’ve really got to communicate with the parents too.
‘‘Little kids are so honest and easy to work with.’’
Baker grew up in the Isle of Man, moved to Nelson in 1993 and said in many ways the two places were similar. Both were surrounded by water, and not easily accessible.
In the 25 years he had spent working in paediatrics, he had seen a shift in the kinds of illness that children presented with.
The rate of infectious diseases had declined and there had been a growth of new, chronic conditions like attention-deficit-disorder and autism.
Baker said one of the biggest differences he had noticed was the effects of immunisation.
When he first started at Nelson Hospital he would see several children each year with meningitis and epiglottitis, which were ‘‘devastatingly, brain damaging diseases’’ and he hadn’t seen a case of either in the last 15 years.
Pneumonia had also made up a large part of his work-load but the Prevenar vaccine had reduced the incidence of that.
Over that time, there had also been a dramatic increase in the awareness of child abuse.
He said the cases that were reported on in the media were the ‘‘tip of the iceberg’’.
‘‘There are a lot of kids where their chances would have been better if they had a more supportive environment and the health sector has a duty to support parents in supporting their kids better.’’
It had led him to become involved with the Safeguarding Children Initiative, which provides seminars for professionals on how to tackle child abuse and neglect through the use of community training and education.
‘‘It was about, how do we make Nelson Marlborough the best place in New Zealand to grow up as a kid.’’
Baker took on the role of chief medical officer at the end of 2013.
He still spends half the week in the general pediatric ward, ‘‘catching babies and dealing with acute admissions’’.
‘‘I think it is quite important to have your feet on the ground and be in contact with people and you can begin to understand the world through their eyes and the challenges facing people.
‘‘If I’m up at 3am catching a baby, I can see how the hospital is ticking.’’
The other half of the week he steps into the chief medical officer role which Baker described as being focused on providing safe, quality, consistent and reliable healthcare.
The job was about dealing with a community of patients and health professionals and multiple systems of healthcare.
Baker spent six years as the president of the Paediatric Society of New Zealand then another six years chairing the National Child Death Review Committee.
Both roles gave him contact with the bigger picture of health systems which led him to take on the chief medical officer role.
‘‘It is not just kids, it is all ages, so I then have to think about the challenges of different groups like our ageing population, but actually, the same things apply.’’
Working on the front line in the health sector had driven Baker towards the more strategic role.
‘‘If what you want to do for your patient can’t happen because of a system, or some kid who presents late with a disease because the parents didn’t know it was a problem, there are lots of missed opportunities.’’
For kids, the established Well Child service ensured children up to the age of five received free healthcare and Baker said a similar programme to help people prepare for old age would be beneficial.
‘‘Where is our routine elder care? There are some lessons across the different age groups, some of the principles are the same.’’
Baker said quite a lot of his time was focused on ‘‘clinical governance’’.
A term coined by the United Kingdom National Health Service, it is defined as a systematic approach to maintaining and improving the quality of patient care within a health system.
‘‘It’s having good teams of staff, it is having the resources needed, it is having the equipment needed, it is having the IT working.
But the most important thing was having an ‘‘intelligent’’ service, Baker said, one that was able to learn from experience.
‘‘An intelligent organisation when things go wrong, it really looks at them and it changes to make that chance less likely.’’
When something went wrong, it was the result of many failures.
It was the swiss cheese model, Baker said. When something went wrong, it was because the holes in the cheese had lined up.
‘‘Even a simple thing like a patient got the wrong dose of medicine, there should have been six or seven safety net layers that could have stopped that happening.’’
It was revealed in November that more than 800 eye patients at Nelson Marlborough Health were at risk of losing their sight while waiting for follow up appointments.
Since then, the health board had prioritised those patients to ensure the most urgent were seen first and had also created a care plan for each.
Baker said the health board aimed to remodel the ophthalmology service by June 30 and reduce waiting times for patients.
‘‘Probably with hindsight we could of seen that coming two years earlier, now my challenge is, what services haven’t yet gotten above the radar?’’
The experience provided an opportunity to be ahead of the game.
‘‘That is the fun and excitement of the job in a way, there are no two days the same, there is always another challenge in terms of that system thinking.’’
Dr Nick Baker was drawn to paediatrics because even the smallest and sickest of patients generally get better. He talks to Samantha Gee.