The Third Revolution

My career in healthcare started almost 30 years ago after I left university, where I’d been studying Modern History. It’s an unusual degree with which to embark on the career path I’ve taken but, though I’ve since done a Masters of Management and Health Policy, I still think history has its place. Thinking about where we have been can often provide a great perspective on the current challenges we face. 

On his recent visit to the Ko Awatea colloquium, Sir Muir Gray did just that. He reflected on the history of healthcare, specifically three revolutions which have changed and are changing the face of healthcare delivery. The first took place in the middle of the 19th century and made common sense advances in public health such as separating sewage from drinking water, improving housing and food, and immunisation. The second revolution was driven by science and saw a shift to hospitals and hospital-based services such as MRI and CT scanning, antibiotics and hip replacements – all of which extended quality and length of life. In some ways we are now the victims of our own success. These two revolutions saw massive increases in life expectancy, from under 50 at the beginning of the 20th century to now closer to about 80 years.

And now we are in the middle of the third revolution.

While a focus on public health and hospitals remains absolutely necessary, it’s time for some change. The public hospital system was set up in New Zealand in the middle of the Great Depression in 1938. Undoubtedly the environment in which we work, and the challenges which we face, have changed significantly since that time.

The third revolution will encompass how we effectively manage chronic disease in an aging population that will increasingly want to be much more in charge of its own healthcare. Working through this and designing what the future delivery of healthcare will look like is a big challenge. At the moment, the health system is perfectly geared towards high-end, high-cost hospital services when what we also need to be doing is developing primary and community care.

It’s a big task. We have to link public health and disease prevention with the need to upgrade hospital services while also developing community-based, primary care capacity. There’s a lot to consider.

But we also undoubtedly have in front of us a once-in-a-lifetime opportunity – to design what healthcare in future will look like, to have a significant and positive impact on people’s lives and wellbeing, and to design the system that will make the next big advances in health.

Responding to that challenge will require vision and bravery. It’s an opportunity which comes with a great deal of responsibility. But we will be pioneers. I hope you find that potential, and the opportunity to be involved, as exciting as I do.



Author: Geraint Martin

Geraint Martin was appointed Chief Executive Officer of Counties Manukau DHB in December 2006. It is one of the largest District Health Boards in New Zealand and services a population of half a million. He has significant experience over 30 years in national policy & in managing both primary and secondary care . Previously, he was Director of Health and Social Care Strategy at the Welsh Government .He authored a radical 10 year strategy of reform, including the successful “Saving 1000 lives” Campaign.Until 2004, he was CEO at Kettering General Hospital & had held senior positions in London & Birmingham.He has worked closely with clinicians in improving clinical standards,patient safety,chronic disease management & managing acute care to reduce hospital demand.In NZ, He has promoted clinical quality and leadership as central to improving patientcare. This has led to a significant increases in productivity and access, whilst maintaining financial balance. CMH has completed in 2014 a $500 m capital redevelopment programme, the largest in New Zealand. A central part of this is the establishment of Ko Awatea,the Centre for Innovation and Research which will underpin CMH as one of the the leading health systems in Australasia.In 2008, he chaired the Ministerial Review of Emergency Care in New Zealand, and in 2013 was an member of the Expert Advisory Panel on Health Sector Performance. Geraint has an MSc in Health Policy from Birmingham University .His post-graduate work has focused on health economics and Corporate Strategy . He is adjunct Professor of Healthcare Management at AUT and Victoria University, Wellington Elected in 2006 as a Companion of the Institute of Healthcare Management, previously he was an Associate Fellow at Birmingham University.He is is Chair of the Auckland Philharmonia Orchestra, a member of the Institute of Directors, on the Board of the NZ Institute of Health Management & previously the Board of The NZ Health Quality and Safety Commission.

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