Recently we have again been reviewing CMDHB’s Health Services Plan, which was published in 2008 and which expressed a twenty year vision for the whole organisation. This plan was primarily concerned with the delivery of healthcare services by CMDHB and focussed very much on bricks and mortar, and therefore hospital beds.
But we now know that the solution will not be so straight forward. Is hospital really the best place to deliver all of the healthcare services it currently does? Certainly Middlemore Hospital cannot meet the overwhelming demand for its services. We can’t afford more beds, we could never build enough, and we would also struggle to resource them.
In line with international trends, we are instead looking to deliver more non acute services in community settings and shift demand away from the hospital. We’ve developed initiatives you will be aware of such as 20,000 Days, which aims to reduce demand on the hospital by working more closely with the community health providers, and Localities Planning, which will significantly increase our partnerships with Primary Care. We’re conscious that we have to address the problems where they arise by providing health services in the community, treating conditions before they become acute, and reducing avoidable hospitalisations.
As well as these initiatives, we’re also looking at the proposal to develop Manukau Health Park. CMDHB has a large site, currently partly occupied by Manukau SuperClinic and Manukau Surgery Centre, which lends itself to further development. Building on the 2008 Health Services Plan, our intention is to develop this site into Manukau Health Park, initially to provide increased elective services and outpatient clinics for sub acute and non acute cases. We’re also considering co-locating Primary Care services, such as Whaanau Ora (Integrated Family Healthcare Centres), after hours services, and diagnostics etc, on site to better integrate healthcare and social services. The development could even extend to the provision of district health board regional shared services such as food service and data storage. Ultimately we want to develop a health park with an integrated service focus which will give our community easy access to the range of services they need.
At the moment we are working through a four step process with Treasury and the MoH Capital Investment Committee, and building a business case under the new Treasury guidelines. We are the first and only DHB in the country to have Treasury and MoH representatives involved in our working and strategic committees to assist us. We’re also collecting a wide range of valued input to the business case, from hospital-based to primary care clinicians, and the community, to ensure we develop a whole of systems solution. An indicative business case should be in Wellington by November and a final business case lodged by early next year.
There is still a huge amount of work required for this project to progress. It would involve a very, very large investment of potentially anywhere from $200 million up to $500 million for CMDHB-related capital over ten years, as well as investment from any third party service providers.
When the business case is more developed we’ll be looking at several funding options, from traditional models to what you may have seen referred to in media coverage as a PPP or public/private partnership. But those discussions are well down the track and there are many questions around affordability to address before we get approval. Despite the hurdles, however, this is a very exciting opportunity, for CMDHB, for its strategic partners and most importantly for the community we serve.
Ron Pearson, Acting CEO