DHB debt difficult to trim: Grant
The outgoing Southern District Health Board commissioner believes financial challenges in the health sector make it difficult to reduce debt as the DHB prepares for its first board election since 2013.
Kathy Grant was appointed as commissioner in 2015 by then Health Minister Jonathan Coleman after the board was sacked, largely due to financial mismanagement and a forecast deficit of $42 million.
Although the deficit had almost been cut in half during her time in the role, Grant was under no illusion that it was easy to reduce debt and said financial challenges in the health sector made it difficult.
These challenges included wage settlements and additional costs involved with the growing demand for health services, she said.
The ongoing financial challenges meant DHBs had to be proactive at reducing debt. ‘‘DHBs are increasingly learning to live within [their] means,’’ Grant said.
Grant pointed to the Waikato District Health Board’s threat of requiring a commissioner as an example of the pressures the health sector faces. The Waikato DHB has until May 3 to respond to Health Minister Dr David Clark with a reason why it should not fire its board members after facing a 2018-19 forecast deficit of $56m.
Although the Southern DHB debt has been reduced since 2015, the health board is still largely in debt, with the 2018-19 forecast showing a deficit of $22m.
Grant was only supposed to be in her role until the 2016 election but the board was exempted, extending Grant’s time in the role to prevent the loss of momentum she had gained.
She will leave her role as commissioner in October, when the board appoints its first chairman and board in four years.
The decision to hold an election was made by Clark, and Grant did not want to comment on whether it was the right time to hold an election or not.
Clark said: ‘‘The DHB has made good progress on changing models of care, and I have greater confidence around its track to sustainability, including reducing deficits.’’
Neville Cook, who was one of the board members fired in 2015, said for democratic reasons the commissioner had held the role for too long. He plans to run for a board position in the upcoming election.
The commissioner had not been successful in achieving the health board’s goals, and, although the Government had increased funding to the DHB significantly, it was still in debt, Cook said.
While Grant acknowledged that government funding had increased, the demand for health services had also accelerated, she said.
The board will have 11 members, of whom seven will be elected and four will be appointed by Clark.
Three of the seven elected members will be elected from Southland.
Although Cook was not happy with commissioner’s direction of the Southern DHB, he believed that three representatives from Southland was fair.
The previous system was fixed, in which anyone from the region could vote for anyone, Cook said. This meant Southland was less likely to be represented, so this way Southland was guaranteed to have some representation, he said.
A showdown is brewing between Northern Southland midwives and the Southern District Health Board over whether maternal and child hubs in Lumsden and Te Anau are safe for emergency births.
Midwife Sarah Stokes said that, despite an assurance from the DHB, she was not confident the hubs were properly resourced, or that she would meet legal requirements if she was using one.
‘‘It’s left me feeling very vulnerable in terms of the way I can practise safely, and I’ll be working with women who are more stressed.’’
Last Friday, midwife Nicky Pealing said the birthing suite at the Lumsden Maternity Centre had no birthing bed or oxygen tanks, which are required for infant resuscitations.
The DHB officially took over the centre on Monday, and it was transitioned from a primary birthing unit to a hub, which would be available for births only in emergency situations.
The Southland Times asked the DHB about Pealing’s claims of missing equipment.
Then on Monday night the Southern DHB’s executive director of strategy, primary and community, Lisa Gestro, said: ‘‘Pregnant women can have confidence that they can use the Lumsden facility in an emergency.’’
She also said the first stage of the DHB’s maternal and child hub was in place in Te Anau.
However, some members of the Northern Southland community believe the DHB may be misleading the public.
The Southland Times again approached the DHB for comment about the missing equipment on Wednesday.
Southern DHB primary care and population health general manager Mary Cleary Lyon replied, saying the DHB was expecting a bed to be in the birthing room at Lumsden as part of the transition.
‘‘With two other beds in the facility, we are confident an urgent unplanned birth can be well managed at the maternal and child hub. A further bed is on its way from Dunedin Hospital.
‘‘Maternal and child hubs, such as those in Te Anau and Lumsden, support antenatal and postnatal care and include space and equipment for planned assessments as well as acute/emergency maternity assessment triage and transport, if needed. They are not intended as places of planned birth, but are available in urgent circumstances.’’
On Thursday, Stokes said no new equipment had arrived in Lumsden, and the Fiordland Medical Centre had not signed an agreement with the DHB to become a hub.
Stokes was concerned that she may not meet legal requirements at a birth at either of the hubs.
Under Section 88 of the Health Act, two medical professionals are required to be at a birth. They could be another midwife, or a general practitioner trained in obstetrics.
Stokes said there were no GPs trained in obstetrics in Northern Southland who could assist.
‘‘The DHB has sent out an email today with the contact details of four midwives that would be able to assist, but they are 40 to 50 minutes away, or even further if you are in Te Anau. As long as we’ve documented that we’ve called someone we are OK, but whether they arrive in time to assist is another thing.’’
The Lumsden Maternity Centre had a midwife onsite to assist midwives with their patients.
Stokes said that, in her opinion, the DHB had not planned well for the transition of the centre to a hub at Lumsden, or for the establishment of the hub at Te Anau.
‘‘It’s been eight months since the announcement was made. I don’t know whether their staff are telling them things have happened and they haven’t. I would hate to accuse them of being incompetent if they don’t really know what is going on, but that is what it looks like to me.’’
The Southern DHB announced in August last year that it would transition the Lumsden Maternity Centre, which was a primary birthing unit, to a maternal and child hub.
Last week Clutha–Southland MP Hamish Walker presented a petition signed by more than 5000 people to the health select committee, asking it to review the DHB’s decision.