The MidCentral Health Study
[This section is based on information supplied by the Chief Executive of MidCentral Health.]
In September 1993 MidCentral Health launched a Clinical Planning Project which was to assess the level of services being offered by Horowhenua, Pahiatua and Dannevirke hospitals using the role delineation model. Palmerston North Hospital had been evaluated under the NSW guidelines the year before as part of the CHEAC process.
This was the first use of the New Zealand model following its adaptation from the NSW version. Two members of the working party who had authored the revised version were hired as consultants to undertake the study.
Pahiatua hospital has 26 beds and offers outpatient clinics only. The study found that the support services were adequate for this level of service. The conclusion reached was that the services at Pahiatua were clinically viable and should continue in their present form.
Dannevirke hospital has 56 beds, and with a resident surgeon offers in-patient surgery. Many clinical services are offered to level 3, and geriatrics to level 4. However, anaesthetics and intensive care services are able to be provided only to level 2, and coronary care to level 1 only, which is not sufficient to adequately support the level of clinical services.
The study recommended that clinical services be temporarily scaled back to level 2 while a project team was set up to look into a suitable response to the study findings. A project team has been established with representatives from Central RHA, MidCentral CHE, local GPs, Tararua District Council and the local community. The draft terms of reference for this project team are included as Appendix 2.
Horowhenua is a 100-bed facility, but like Pahiatua offers clinical services to level 2 only. It was found that the services offered met the guidelines, and should continue in their present form. Moreover, it was noted that there was a high degree of linkage between Horowhenua and Palmerston North hospitals. There are extensive outpatient clinics held at Horowhenua by visiting specialists from Palmerston North, and frequent clinical liaison occurs at ward level. It was considered that this provided an excellent example for Pahiatua and Dannevirke hospitals to follow.
Performance Monitoring of CHEs
As noted above, the role delineation model examines only one part of total hospital operations. There are many issues that the model does not address. While it is useful for measuring clinical viability, further assessment of other significant issues is required to determine the place for rural surgical services. A further means of assessing the place for rural surgical services is performance monitoring. Although performance monitoring in various forms is undertaken by the Ministry of Health, RHAs, Treasury and other agencies, the next section will focus on the performance monitoring of CHEs by the Crown Companies Monitoring Advisory Unit (CCMAU), outlining the process and the performance indicators used.
CCMAU
Crown Health Enterprises, like SOEs, are monitored to ensure that they are providing the best return (in terms of quality of service for public money invested) to their shareholding Ministers [- In the case of CHEs, the shareholding Ministers are the Minister of Finance and the Minister for CHEs] on behalf of the New Zealand public. This monitoring is carried out by the CCMAU, a Government agency.
The health division of CCMAU was previously known as the Crown Health Enterprise Monitoring Unit (CHEMU), which in turn developed from the Crown Health Enterprise Establishment Unit (CHEEU) under the Department of the Prime Minister and Cabinet. It has about 12 staff.
CCMAU is responsible for both the performance monitoring of CHEs and for the distribution and development of the role delineation guide. They see the two as complementary steps of the management process, with the safety and quality of clinical services being an important component of overall CHE success.
Contact for Enquiries
Rural Affairs Coordinator
Sector Performance Policy
MAF Policy
Ministry of Agriculture and Forestry
PO Box 2526
Wellington
NEW ZEALAND
Phone: +64 4 894 0675
Fax: +64 4 4 894 0745
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