Lessons to learn from Kiwis on health care

TEN years ago, Canterbury Health Board in New Zealand was faced with a healthcare system that was “beginning to look unsustainable”. Its population of around 510,000 was ageing rapidly, waiting times were growing and hospital admissions were on the rise.

The main hospital in Christchurch was regularly “gridlocked” as patients backed up the A&E department while the hospital ran out of beds. It was estimated that it would require another 500-bed hospital, a 50 per cent increase in residential care beds for the elderly and 8,000 extra staff by 2020 just to standstill, a prospect which was completely unaffordable.

Sound familiar? The challenges facing the NHS can seem depressing and insurmountable but other nations show us that change is possible. A decade after hitting its own crisis, Canterbury has earned plaudits for its “one system, one budget” model of health and social care.

The New Zealand healthcare system is broadly similar to the UK’s, with a few crucial differences. Although it is funded from general taxation and free at the point of use, patients pay to visit their GP (a fee of around £30 to £45 for out-of-hours) and health boards use a national scoring model to ration care.

As a result, not all procedures will be automatically provided on the health service; for example, a patient with haemorrhoids may have to put up with the condition, go private or pay for it with health insurance.

The system offers food for thought in a week when the chairman of the BMA in Scotland, Dr Peter Bennie, reiterated his call for an honest debate on what the Scottish health service can and cannot deliver on its budget. An early step in New Zealand was to ask GPs and hospital doctors to draw up local “HealthPathways” agreements, stipulating which treatments can be managed in the community; which require a referral; and tests to conduct prior to a referral. GPs carry out many more diagnostic tests and subsequent procedures, including the removal of skin lesions, in some cases dramatically cutting waiting times for procedures once routinely carried out in hospital.

Out-of-hours care is provided by GPs and includes a 24-hour GP-run care facility in Christchurch handling almost as many patients as the emergency department but preventing less serious cases clogging up A&E.

In Christchurch hospital, a computer programme can predict acute demand three days ahead with 99 per cent accuracy, considerably improving workforce planning, while pharmacists review patients taking multiple medications at home to prevent unscheduled hospital admissions, a major problem among the elderly.

GPs can also call on an Acute Demand Management System for patients requiring regular home checkups, such as a child with gastroenteritis or an elderly patient with mild pneumonia. The same scheme is also credited with halving winter chronic obstructive pulmonary disease admissions to hospital in Canterbury. Ten years on, demand for elderly care home beds has plateaued, waiting times are down and A&E gridlock is rare. Yet public spending did not increase dramatically; not perfect but the NHS could learn a lot from it.

‘‘ Ten years on, demand for elderly care home beds has plateaued, waiting times are down and A&E gridlock is rare