A Letter from the CEO

Following my recent announcement about Achieving the Balance, here is a letter I’ve written to all staff and to the wider community for the upcoming issue of Connect. Please take a look to find out more about Achieving the Balance and what it means for Counties Manukau…

Dear Colleagues,

Welcome to the Spring edition of Connect. I would like to take this opportunity to express my sincere thanks to all staff who have worked so hard to deliver services to an unprecedented number of patients in the last few weeks. We all hope the impending warmer weather will give some well-deserved respite.

For some time now I have been talking about the need for some fundamental changes in how we deliver health services to our population in order to cope with the increasing demand from an expanding and aging population. The work done by Dr Gary Jackson has clearly signalled to us that we have no time to waste and that the need for change is being thrust upon us sooner than we initially believed.

How to deal with this change?  Well, we cannot keep building new hospitals ad infinitum. So, how can we thrive in this environment – remember we have the population equivalent of Hamilton moving into our DHB area over the next few years. We can look towards primary care as the ‘engine room’ of the new health model. We can invest in programmes that keep patients well and keep them in the community. Secondary care should be focussed on that which is truly hospital based. Hospitals are a very expensive way of providing community and chronic care.

We need clinicians to lead this change as it is about changing how we work and practice. We need to invest in training and improving capability, and ensure that it is well managed to achieve the best gains. We need to work much better with our partners, primary care, NGOs and other DHBs. And we need to be bold. The challenge is so significant that we cannot manage by becoming more efficient plus doing some small scale change alone. Indeed this will lead to change for all of us, but by not changing we are running a much greater risk for our staff and patients.

The major strategic projects are linked together as a whole, but are very focussed on delivering changes to key areas.

To ensure ” business as usual” is made as safe and as viable as possible, we have already set up Middlemore Central to co-ordinate hospital care effectively. To this we will add a second phase of our programme to improve quality and reduce waste. Last year, through “Thriving in Difficult Times” we set a target of $10m, but you delivered $22m  – this was critical in ensuring finances without cutting jobs or services. This year our aim through “T2” is to save $20m through working smarter. Already senior managers and clinicians have begun to identify the work streams and opportunities. In addition we are identifying the top “Wicked Issues” which we need to address – changes to the way we work – which will make working easier and better for you and patients. An early focus will be on seeing how we can better design the system for managing emergency surgery.

There will be two major projects which will focus on building the capacity needed to manage patients better and at home so they need hospital care less than in the past. The first is to divide Counties into six specific localities, each with their own particular health needs. We will work through partnerships with primary and secondary clinicians to ensure services are developed to keep people well and at home. The second is to ensure that over the next two years the equivalent of 20,000 bed days – about 5% of our total, take place in the community, not hospital.

Taken together this whole initiative is called “Achieving a Balance”. A balanced health system designed to do the right thing, at the right place, at the right time, in the right way. But also one designed to ensure a balanced working life for staff – where you have the time and the support to practice at your best, with time to spare.

I need you to be leaders and implementers of change, to fully understand what your part in this will be and how you can contribute to our success in the coming months. A major part will be ensuring we engage you not just in being part of the change, but the people who drive it. I have often said it is those on the frontline who know the answers, and the task of the management team to ensure we find out what they are and empower you to deliver them.The capacity we have built through Ko Awatea will be used to do much of this redesign work. We are not alone in feeling the need to change but we are at the forefront in addressing it. It is the start of another chapter in South Auckland’s history of innovation and leadership in health in New Zealand.

I look forward to writing it with you, and  thank you in advance for your support and dedication as we move into the next phase of health delivery in South Auckland.

Best wishes

Geraint Martin



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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