Healthcare review ends $400m crisis

By ANGELA GREGORY

Strategies to cut down acute admissions at Middlemore Hospital have avoided a healthcare crisis which would have required a new $400 million hospital.

A paper published by the New Zealand Medical Journal shows how the Counties Manukau District Health Board turned around high acute admission rates - which had been rising by 9 per cent a year - by improving integrated care.

It says had it not done so a new hospital would have had to be built within five years.

In 1998 the board had been experiencing rapidly increasing demands on its secondary services, and was finding it difficult to meet the health needs of its relatively deprived population.

The community had always had a high level of needs with one third of the population living in poverty.

There was a significant health status gap between Counties Manukau children and the national average.

Half of its Pacific Island children needed hospital care in their first year of life.

Middlemore and KidzFirst hospitals were being swamped.

Acute adult and paediatric medical admissions were growing by 9 per cent a year over 10 years, despite a population growth of only 2 per cent.

The board calculated there were 12,000 avoidable admissions to Middlemore annually. It hired international health management consultants who found many system failings, including erratic communication between primary care providers and between the hospitals and primary care.

A strategic plan was devised with 30 separate projects undertaken to improve co-ordination and integration of health services.

It aimed to improve delivery of healthcare to Maori and Pacific communities failing to access existing services, develop systems to increase immunisation and well-child checks, and improve breast-feeding rates.

The management of people with chronic disease was improved, and alternatives developed to hospital referrals by improving the range of acute medical services available to primary care.

In an editorial on the paper, Barry Gribben, senior research fellow at the Department of General Practice and Primary Health Care at the University of Auckland, said the problem of integrating hospital and general practice systems was a recurring theme.

The results to date from the projects were promising, but they were not yet proven to be sustainable, or even generalisable.

"The unique circumstances of Counties Manukau District Health Board may well have been responsible for the impact of the initiatives,"he said.