Canterbury Charity Hospital Trust & Canterbury Charity Hospital Trust & Unmet Need for Secondary Healthcare Unmet Need for Secondary Healthcare

ServicesServices

ASMS 27ASMS 27thth Annual Conference Annual Conference2020thth November 2015 November 2015

Phil BagshawPhil BagshawChair, CCHTChair, CCHT

By the community; for the communityBy the community; for the community

NZ Health Reforms & NZ Health Reforms & Healthcare Rationing Healthcare Rationing

Core Services Committee 1992.Core Services Committee 1992. National Waiting Time Project National Waiting Time Project

1998. Changes to Health Lexicon1998. Changes to Health Lexicon By September 2006 - 24,000 By September 2006 - 24,000

patients were refused First patients were refused First Specialist Assessment & 22,000 Specialist Assessment & 22,000 removed from waiting lists.removed from waiting lists.

Result Increasing unmet need.Result Increasing unmet need.

Sharon CrosbieSharon Crosbie

The Press, Christchurch. 25The Press, Christchurch. 25 thth August 1998 August 1998‘‘New booking system a scam, says surgeon’New booking system a scam, says surgeon’

His waiting list stretches to about 150 people

© Fairfax Media© Fairfax MediaReproduced with permission 9Reproduced with permission 9thth October 2015 October 2015

National Waiting Time Project National Waiting Time Project Orwellian SpeakOrwellian Speak

When they say – “The When they say – “The waiting list is only four waiting list is only four month long”.month long”.

They mean – “If your They mean – “If your operation won’t be done operation won’t be done within four months we within four months we won’t have you on our won’t have you on our waiting list”.waiting list”.

Neologist; Dystopionist

Acceptance Pipeline for Public Hospital Elective HealthcareAcceptance Pipeline for Public Hospital Elective Healthcare

Reservoir of Community Need

Community Expectations

GP Expectations

‘Health Pathways’

First Specialist Assessment

Clinical/Financial Priority Thresholds

National Waiting Time Standards

Accepted for Treatment

Disease

Reservoir of Community Need

The hateful metaphorThe hateful metaphor““..... altering the ..... altering the trajectory of demand”trajectory of demand”

Apart from adults who Apart from adults who get surgery each year:-get surgery each year:-

Another 280,000/yr Another 280,000/yr told they need surgery told they need surgery

Of these:170,000 aren’t Of these:170,000 aren’t recorded anywhererecorded anywhere

Survey criticized as Survey criticized as biased by Minister of biased by Minister of Health.Health.

How much unmet need for elective surgery is How much unmet need for elective surgery is there?there?

RACS Conference – RACS Conference – 2525thth June 2003 June 2003

CCH Trust Formed – CCH Trust Formed – 2929thth July 2004 July 2004

Major ConceptsMajor Concepts

Canterbury-wide access for some patients who Canterbury-wide access for some patients who can’t access secondary elective health care.can’t access secondary elective health care.

Only two full-time paid employees.Only two full-time paid employees. All doctors, nurses, anaesthetists, legal, All doctors, nurses, anaesthetists, legal,

businesses, businesses, etcetc donated donated pro bonopro bono.. Community volunteerism for other jobs & Community volunteerism for other jobs &

services.services. Totally funded by public donations.Totally funded by public donations.

Mount Pleasant BC

Sweet Adelines

R. Hadlee ElevenR. Hadlee Eleven

Hagley Park Hagley Park EventsEvents

St Andrew’s CollegeSt Andrew’s College Cust Charity Bike RideCust Charity Bike Ride

349 Harewood Road Purchased 349 Harewood Road Purchased 1515thth August 2005 August 2005

Andrew Sutherland, President RACSAndrew Sutherland, President RACS Opened original East Wing 12 Opened original East Wing 12thth October 2007 October 2007

Colonoscopy 1795Colonoscopy 1795

Who gets to be a patient?Who gets to be a patient?

Can’t access public health care.Can’t access public health care. Condition affecting quality of life or Condition affecting quality of life or

employment.employment. Can’t afford private care; no health Can’t afford private care; no health

insurance; don’t qualify for ACC.insurance; don’t qualify for ACC. Signed declarations of qualification.Signed declarations of qualification.

Objectives: Objectives: Timely & Timely & High Quality TreatmentHigh Quality Treatment

1.1. More HumaneMore Humane The ‘Dear John Letter’The ‘Dear John Letter’ Serious feelings of ‘anger; Serious feelings of ‘anger;

abandonment & loss of hope’.abandonment & loss of hope’.2.2. More Cost-EffectiveMore Cost-Effective

Less complicationsLess complications Quicker return to work, Quicker return to work, etcetc..

3.3. Investment pays fiscal dividends Investment pays fiscal dividends ((Reeves AReeves A et al. Global Health et al. Global Health 2013;9:43).2013;9:43).

Clinical Day Services OfferedClinical Day Services Offered

Groin/Abdo HerniasGroin/Abdo Hernias HaemorrhoidsHaemorrhoids Varicose VeinsVaricose Veins Cataracts/SquintCataracts/Squint Dental/Oral SurgeryDental/Oral Surgery Carpal Tunnel & Carpal Tunnel &

Dupuytren’sDupuytren’s ColonoscopyColonoscopy

Women's health Women's health sterilizations, sterilizations, etcetc

Orthopaedics upper & Orthopaedics upper & lower limblower limb

PodiatricsPodiatrics Counselling/PsychCounselling/Psych List alters to respond to List alters to respond to

changes in unmet need & changes in unmet need & resource availability. resource availability.

Staff VolunteersNumbers Who

Ever Worked Since 2005

Numbers Who Worked In 2014

Nurses 101 42

Anaesthetists 31 18

Physicians 11 0

Surgeons 56 24

Dentist/Dental Nurses 34/26 12/14

Counsellors/Psychologists 63 5

Technicians 14 5

Non-Medical 126 58

Part Time Employees 5 3

Full Time Employee 4 1

Clinical & Administrative Staff Composition Clinical & Administrative Staff Composition of Charity Hospital by 31of Charity Hospital by 31stst December 2014 December 2014

CalenderYear

2005 -2007

2008 2009 2010 2011 2012 2013 2014

Initial Appointments

35 199 375 405 290 206 350 361

Follow-up Appointments

22 125 221 173 346 193 216 289

Total Number ofAll Treatments

22 228 368 242 1578 1023 1396 1201

Numbers of Outpatient Appointments, Surgical Procedures Numbers of Outpatient Appointments, Surgical Procedures & Counselling Sessions by 31& Counselling Sessions by 31stst December 2014 December 2014

Setup & Average Annual Setup & Average Annual Running Costs ($NZ)Running Costs ($NZ)

Setup Cost All 3 Buildings - $4.5 millionSetup Cost All 3 Buildings - $4.5 million Annual Running Costs - $680,000Annual Running Costs - $680,000 All met by public donations, bequests & All met by public donations, bequests &

special fundraising activities.special fundraising activities. 82% goes on direct patient treatment costs.82% goes on direct patient treatment costs.

Tribute To The VolunteersTribute To The Volunteers

Other Groups Addressing Unmet NeedOther Groups Addressing Unmet Need

ExamplesExamples

Auckland Regional Auckland Regional Charity Hospital.Charity Hospital.

Taranaki Community Taranaki Community Health Trust.Health Trust.

ARCH DirectorsARCH Directors

www.aucklandcharityhospital.org

National Studies of Unmet Need for National Studies of Unmet Need for General Secondary Healthcare ServicesGeneral Secondary Healthcare Services

Canada & USACanada & USA ItalyItaly ThailandThailand Sierra LeoneSierra Leone

Government to measure unmet 2ry Government to measure unmet 2ry healthcare need through GPs practiceshealthcare need through GPs practices

Dr Jonathon ColemanDr Jonathon Coleman The Press 10The Press 10thth June 2015 June 2015

TV3 The Nation 24/10/15TV3 The Nation 24/10/15

Others are joining in: e.g. Canterbury DHB Audit

STAGE 1: Pilot Study of Methods to Measure STAGE 1: Pilot Study of Methods to Measure Unmet Secondary Healthcare NeedUnmet Secondary Healthcare Need

InvestigatorsInvestigators

A Prof Phil BagshawA Prof Phil Bagshaw *† *†

Dr Sue BagshawDr Sue Bagshaw *† *†

Prof Chris FramptonProf Chris Frampton * *

Prof Robin GauldProf Robin Gauld ** **

Dr Terri Green Dr Terri Green §§

Prof Andrew HornblowProf Andrew Hornblow § §

Dr Ben Hudson Dr Ben Hudson **

Dr Antony RaymontDr Antony Raymont ¶ ¶

Prof Ann RichardsonProf Ann Richardson § §

Prof Les ToopProf Les Toop * *

Mr Carl ShawMr Carl Shaw † †

Study ArmsStudy Arms

Auckland & ChCh PHOsAuckland & ChCh PHOs GP prospective clinical GP prospective clinical

database case recordingdatabase case recording Balanced population Balanced population

sampling by:sampling by:

** Face-to-face interviews Face-to-face interviews

** Telephone interviews Telephone interviews

** Web-based survey Web-based survey

* University of Otago, ChCh; ** University of Otago, Dunedin; § University of Canterbury; ¶

Auckland Independent Heath Researcher; † Canterbury Charity Hospital Trust, ChCh

Progress ReportProgress Report

Funded by: Funded by: CMRF; ASMS; HM Trust; CMRF; ASMS; HM Trust; RTATC Trust; Anon Trust; CCH Trust.RTATC Trust; Anon Trust; CCH Trust.

3 Population Survey Arms: 3 Population Survey Arms: Research FirstResearch First Status: 3 Survey Arms underwayStatus: 3 Survey Arms underway Timeline: Survey Arms completed by end Timeline: Survey Arms completed by end

2015; GP Arm completed by March 2016. 2015; GP Arm completed by March 2016.

STAGE 2: Independent Biennial Assessment of STAGE 2: Independent Biennial Assessment of Unmet Secondary Healthcare Need with Public Unmet Secondary Healthcare Need with Public

Reporting ProcessesReporting Processes

Gauld Gauld et alet al NZMJ 2014;127:63-7 NZMJ 2014;127:63-7

BartmanBartman

We The Medical Profession Have Let The We The Medical Profession Have Let The Public DownPublic Down

Questions for NZ Medical CollegesQuestions for NZ Medical Colleges

What are their official positions on unmet What are their official positions on unmet secondary healthcare need?secondary healthcare need?

What do they intend to do about it?What do they intend to do about it? Do they support an independent, robust Do they support an independent, robust

system for its regular assessment and public system for its regular assessment and public reporting?reporting?

Thank you ASMS for your supportThank you ASMS for your support

John Donne (1572 - 1631)John Donne (1572 - 1631)WhyWhy bother?bother? - - Devotions upon Emergent Occasions;Devotions upon Emergent Occasions; Meditation XVII Meditation XVII

"No man is an Island, entire "No man is an Island, entire of itself; every man is a piece of itself; every man is a piece of the Continent, a part of the of the Continent, a part of the main; ……… any mans death main; ……… any mans death diminishes me, because I am diminishes me, because I am involved in Mankind; And involved in Mankind; And therefore never send to know therefore never send to know for whom the bell tolls; It for whom the bell tolls; It tolls for thee."tolls for thee."