YEAR OF WOE
Waikato DHB dominated news headlines in 2017 but rarely for the right reasons, health reporter Aaron Leaman writes.
Roy Lewis is facing a summer of pain. In August, the Cambridge man was referred by his GP to Waikato Hospital’s orthopaedic clinic. After months spent battling intense sciatica, the 74-year-old was given a hospital appointment for late December, only to have it put off until February.
He’s now relying on a medley of pain relief to get him through the next few months.
‘‘It’s a Third World situation. I’m frightened I’m going to be in pain for a long time,’’ Lewis says.
‘‘But I’m not alone. There are a lot of things that aren’t right with the health system at the moment.’’
Lewis’s observations are pertinent when it comes to the Waikato District Health Board.
Even those of a charitable persuasion would struggle to put a positive spin on the past 12 months for Waikato’s ‘‘village on the hill’’.
After a drumbeat of scandals, leaks, and resignations, 2017 can best be described as a grim year for the Waikato DHB.
Waikato’s bold bid
The year started on a positive note as the district health board pushed ahead with its bid to create the country’s third medical school.
The proposal, pitched in partnership with Waikato University, seeks to put graduate-entry students through four years of training, including one year based in a community setting. It’s been almost 50 years since New Zealand last established a medical school.
The Waikato bid draws inspiration from successful overseas models and focuses on addressing the needs of disadvantaged, rural and provincial communities.
Currently, New Zealand recruits 1100 overseas doctors each year. Only one in four remains in the country after five years.
Momentum behind the proposal built throughout the year as community and business leaders came out in support of the bid.
In February, Sir Owen Glenn pledged $5 million toward the bid, saying a shortage of primary care providers had caused social and economic upheaval in rural and high-need communities.
Waikato and Bay of Plenty mayors also backed the bid, as did community leaders from the South Island’s West Coast.
The country’s two established med schools, unsurprisingly, slammed the Waikato proposal, describing it as ‘‘expensive folly’’.
Otago and Auckland universities later pitched a rival bid to create a national school of rural health, despite previously rejecting claims of a chronic shortage of health professionals in rural communities.
Tensions between the rival camps continued through to August when then prime minister Bill English announced plans to create a school of rural medicine.
The Labour-led Government is expected to make a call in 2018 on whether to forge ahead with a new med school.
Unfortunately for backers of the Waikato bid, one of its keenest advocates could prove to be its undoing.
Nigel Murray
Former Waikato DHB chief executive Nigel Murray, in partnership with Waikato University vice-chancellor Professor Neil Quigley, became the public faces of the Waikato med school bid following its launch in October 2016.
Murray proved a willing champion of the proposal and spoke passionately at public forums about the need to shake up doctor training in New Zealand.
But for all of Murray’s bravado, a proverbial time bomb sat ticking at his feet.
On July 26, 2017, Murray abruptly went on leave following allegations of unauthorised spending.
DHB management initially said Murray was on holiday having built up a sizeable amount of annual leave. He never returned.
Murray formally resigned on October 5, part way through an independent investigation which found he had misspent health dollars during trips, both abroad and within New Zealand.
Investigators also found he overspent on agreed relocation costs during his shift from Canada to Hamilton in 2014.
The search to find a new DHB chief executive could take 18 months.
During his three-year tenure, Murray chalked up a staggering $218,166 in expenses – including $71,811 of unauthorised spending.
His resignation was accepted by the DHB on the basis he pay back funds owed.
Murray was hired by the DHB in 2014 despite warnings from senior medical staff about his management style – described as ‘‘control and command’’.
Waikato DHB chairman Bob Simcock repeatedly defended the recruitment process used to hire Murray, saying all necessary checks were carried out.
Simcock’s comments, however, only fuelled calls for him to go and, on November 28, he quit.
Speaking exclusively to the Waikato Times after his resignation, Simcock said he regretted employing Murray.
An Audit New Zealand review of Murray’s expenses, released on November 30, found the disgraced health boss travelled on the taxpayers’ dime without approval and enjoyed overseas trips when supposedly on sick leave.
Auditors also found Murray flouted DHB policies when he charged the health board for personal expenses and often booked accommodation with a nightly rate in excess of $250.
In the past financial year, Murray racked up expenses totalling $91,506. By comparison, Murray’s predecessor, Craig Climo, spent $9750.60 during his final 18 months as Waikato DHB chief executive.
Even those closest to the DHB might struggle to predict where the Murray saga will end.
On November 3, Health Minister David Clark directed the State Services Commission to investigate the allegations regarding Murray’s spending.
Clark said such allegations risk damaging confidence in the public sector.
The Serious Fraud Office also started preliminary inquiries into Murray’s spending.
Following Audit New Zealand’s review of Murray’s expenses, State Services Commissioner Peter Hughes requested Deputy Auditor-General Greg Schollum investigate the Waikato
‘‘There are a lot of things that aren’t right with the health system at the moment.’’
Roy Lewis Waiting since August for orthopaedic clinic appointment at hospital
DHB’s showpiece virtual health project, SmartHealth.
SmartHealth was Murray’s signature project during his tenure at the DHB.
Hughes said he had concerns with the health board’s investment in SmartHealth and also asked for a probe into the DHB’s contract with HealthTap, the online platform used to deliver SmartHealth.
The board purchased the HealthTap platform in 2015 with the aim of giving people access to doctors via smartphones and tablets but, to date, has struggled to attract users.
The health board’s two-year contract with HealthTap costs taxpayers US$5 million per year.
The DHB also signalled it would carry out an independent review of HealthTap.
Aside from any reputational damage to the DHB – and its med school bid – the Murray saga hit taxpayers in the back pocket.
To date, the DHB’s own inquiries into Murray have cost more more than $150,000.
Staff under pressure
The winter months proved especially challenging for Waikato Hospital staff.
An influenza season was declared in June as Waikato Hospital’s emergency department experienced some of its busiest days on record.
At times the lack of beds inside the ED became so dire, people were forced to stay in – and tie up – ambulances outside as they waited for space to free up.
Patients were also put into hospital corridors because of overcrowding.
In response, the DHB embarked on a series of initiatives to ease pressure on the ED, including a recruitment programme to boost staffing levels.
Strain also began to show across other hospital departments.
On November 24, staff in the hospital’s radiology department held a stopwork meeting to air concerns over workload pressures and staff shortages.
Dr Deborah Powell, national secretary of the Association of Professional and Executive Employees (Apex), accused hospital management of allowing the department to fall into crisis and said staff morale had hit rock bottom.
If matters inside the radiology department weren’t fixed, it could threaten the day-to-day functioning of Waikato Hospital, Powell warned.
Waikato DHB executive Mark Spittal said staffing shortages within the department weren’t driven by any savings initiative, but acknowledged management had to beef up staffing numbers.
Further bad news hit the DHB when its status as the region’s water watchdog was suspended.
International Accreditation New Zealand (IANZ) suspended the DHB’s drinking water accreditation in December citing concerns over a chronic shortage of drinking water assessors at the health board and a significant backlog of work.
In other developments, Waikato Hospital was forced to overhaul the workload of junior doctors in orthopaedics following concerns it could lose its training accreditation.
A report by the New Zealand Orthopaedic Association found the volume of elective surgery for trainees fell short of expectations. Hospital managers submitted a plan aimed at giving registrars more balance in the surgeries they undertake – including more exposure to elective surgeries.
The heath board was stripped of its accreditation for obstetrics and gynaecology in 2015 after failing to meet three of seven standards set by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG).
All indications are the DHB is on track to regain its accreditation this year.
Arguably the most pressing concern for a health board with aspirations to set up its own med school, was a review by the Medical Council of New Zealand which found the DHB’s training of young doctors did not meet four of 22 sets of standards.
The health board has six months to turn things around or risk losing accreditation.
The medical council’s report also included allegations of bullying of young doctors by senior colleagues.
The findings prompted the DHB to launch an independent review into bullying in its general medicine department.
A board divided
When Simcock stepped down as chairman in November it was clear he no longer had the full support of the board.
Repeated leaks from board members undermined his leadership and ensured the DHB rarely slipped out of the public spotlight.
Deputy chair Sally Webb stepped in as acting chair following Simcock’s resignation and quickly signalled an intent to make the health board more open to public scrutiny.
She released Audit New Zealand’s review relating to the DHB’s procurement of HealthTap, saying it was in the public interest.
Derek Wright’s appointment as interim DHB chief executive was also welcomed by hospital insiders who commented on his ability to listen and work closely with staff.
However, it would be naive to think the Waikato DHB’s fortunes can be instantly revived with the departure, or arrival, of a couple of personnel.
Even prior to Murray’s arrival, the health board was wrestling with significant problems.
A Health Ministry report in 2014 found the DHB had too many managers, staff were kept in the dark, communication between departments was poor, and it was too slow to provide treatment. But it’s not all doom and gloom. Among the board’s current crop of elected members, newcomer Dave Macpherson has been a standout performer.
Macpherson was relentless in his efforts to hold the DHB publicly accountable over the Murray saga. He also showed an ability to ask the tough questions, while also serving as a compassionate touchpoint for patients and their families.
Other strong contributors around the board table include Clyde Wade, Sally Christie and appointed member Tania Hodges.
Elected board member Mary Anne Gill provided informed, insightful comments during DHB discussions but came under fire after reports surfaced of a dud deal she negotiated and signed off while serving as the Waikato DHB communications director in 2013.
The deal, which would have seen the Chiefs rugby franchise become the face of the DHB’s WaiKids brand, was later cancelled but not before it had cost taxpayers $50,000.
However, the two board members with the biggest question marks hanging over them also happen to be among the DHB’s most experienced community advocates: Pippa Mahood and Martin Gallagher.
Mahood, who has been on the board since 2004, often wears the look of someone perpetually peeved but her discontent rarely results in any probing questions.
During the unfolding Murray saga, Mahood told reporters that responding to media requests for comment wasn’t a priority for her.
Gallagher also failed to make an impression during DHB discussions, appearing content instead to offer up compliments and tributes to staff.
When sworn in as Hamilton’s deputy mayor, Gallagher publicly said he could balance the role with his DHB commitments.
Those accustomed to Gallagher’s energy and gusto during city council debates will be looking to him to inject the same sort of passion into health board meetings in 2018.