DHB boss: ‘Always unmet need’
Southland’s former health boss wishes he could have solved the region’s GP crisis and nursing shortage before leaving his post.
He also would have liked to see more progress on the new Dunedin Hospital build and less bureaucracy to get infrastructure projects like the ED expansion at Southland Hospital approved.
Former Southern District Health chief executive Chris Fleming stepped down last week, marking the end of a 30-year career in healthcare.
The job has been by far his most challenging, he says, and there’s still lots that need to be done to improve services in Southland and Otago.
‘‘This is the only DHB that’s got everything,’’ Fleming says, referring to the scale and complexity of services delivered in the district.
A road trip around the district spans 750km and there are more people here who live further than two hours from a hospital than anywhere else in the country.
Residents live in small clusters far away from each other and delivering services close to their homes is sometimes costly.
But the DHB had been funded according to how many people its supports and with just 330,000 residents, the district doesn’t have the population mass to support its geographical challenges, Fleming says.
He is somewhat disappointed that he hasn’t been able to solve the district’s fiscal woes completely over the past six years, but pragmatically, there was only so much he could do without compromising patient care, he says
‘‘The underlying factor is the underfunding of the [health] sector.’’
Years of underfunding in New
Zealand’s health system meant the DHB had to continue investing in improvements and cover rising medical costs for a growing population while also trying to shrink a deficit.
When he joined the DHB in 2016, then Minister of Health Jonathan Coleman had just sacked the entire board and replaced them with a commissioner over a deficit that was expected to blow out to between $30 and $42 million.
Southland and Otago accounted for 160% of New Zealand’s total DHB deficit at the time.
These days, it accounts for about 3 or 4% with a year-to-date deficit of $21.863m in June, as it grapples with costs related to Covid-19, staffing shortages and outsourcing.
While he knows that people want services closer to home, someone must have ‘‘the courage to come up with a national plan’’ for how healthcare is delivered that’s ‘‘realistic about the money’’ and finite staff and infrastructure, Fleming says.
He means that in some cases, it’s too expensive to offer specialist treatments in too many places.
In other cases, it means moving services, so they’re more evenly distributed. That was the thinking behind the DHB’s controversial decision to downgrade the Lumsden Maternity Centre.
Fleming stands by the decision, despite the strong criticism and opposition he received from the northern and western Southland communities.
‘‘In an ideal world, we’d have primary birthing units everywhere.’’
But having three primary birthing units close together (in Lumsden, Winton, and Gore) wasn’t logical when there wasn’t one in Wānaka, he says.
It’s this rationed nature of New Zealand’s healthcare system that also makes Fleming believe Southlanders should be grateful for the community-funded Southland Charity Hospital, rather than seeing it ‘‘as a blight’’ on the health system.
Under his leadership, the Southern DHB had committed to supporting the charity hospital wherever possible, he says.
The hospital was founded in response to patients struggling to access colonoscopies.
The subject of colonoscopy access has been raised repeatedly during Fleming’s time with the DHB, leading to a series of internal and independent reviews from 2017 and a public apology from the board in October 2020.
The reviews found that delays and strict criteria for colonoscopy wait lists were causing harm to patients because their bowel cancer was diagnosed too late.
Fleming says he lost sleep over these stories of patient harm and adverse events – not just in terms of colonoscopy services.
Equally concerning to him was the ‘‘urology disaster’’ – when a review found that at least 10 prostate cancer patients had their lives cut short while waiting seven months for urgent surgery.
Earlier this year the board were told that more than 3000 patients were overdue for ophthalmology appointments, and long oncology wait lists that were described as ‘‘criminal’’ last year have been further delayed by Covid-19 and staffing shortages.
But there’s a sad irony to the fact that these ‘‘darkest days’’ also produced his proudest moments, he says, in the sense that he’s proud of the improvements made in these departments.
‘‘Each and every one of those issues has been worked through. Where we’ve turned a rock over we’ve been very open in the public about it,’’ Fleming says.
But he warns: ‘‘We can’t be complacent, it doesn’t take much of a population shift to change again.’’
Health New Zealand will need to keep investing and increase service capacity if it wants to keep up with the rapid population growth in the district.
Fleming says it will be important for Southlanders to hold the new health authorities to account, to keep engaging and to keep pushing for what they need – because a lot of creative ideas come from the region.
And New Zealand needs to do more to grow the nursing workforce.
‘‘It’s obvious that we didn’t take enough action five to 10 years ago. We can’t blame this on Covid.’’
But if there was ever a time for change, it was with strong Pasifika and Māori wāhine leading the health system, Fleming says, referring to Health New Zealand interim chief executive Margie Apa and Māori Health Authority Interim Chief Executive Riana Manuel.
The health reforms gave Fleming a chance to pause and ask himself what he wanted to do with the next 10 to 15 years of his working life.
Running a regional health structure wasn’t high on the agenda, so when his son suggested they look for a business to run as a family, he was in.
They’ll be operating two Paper Plus stores 100km apart in the Waikato – where the family are from – and Fleming says it will give him the opportunity to give his son a head start.
When he joined Crown Health Enterprises as an accountant back in the early 90s, it was to avoid the regional transfer his previous employer was suggesting.
He stayed in the industry because of the kind of people who worked in healthcare and because it consistently challenged him to find solutions, he says.
‘‘I realised that no matter what I’d done, there was still more to do. It got me hooked.’’
Fleming isn’t convinced he’ll leave healthcare completely.
He’s already been offered opportunities to consult, particularly in the aged care sector – because he does come with three decades of experience after all.
New Zealand’s 20 District Health Boards have been dissolved as part of a major health overhaul.
As of Friday, they merged into a single entity known as Health New Zealand, while a Māori Health Authority will work alongside the new agency to achieve health equity.