Canterbury Charity Hospital Trust & Unmet
Need for Secondary Healthcare Services
By the community; for the community
Phil Bagshaw
Chair, CCHT
ASMS 27th Annual Conference
20th November 2015
NZ Health Reforms &
Healthcare Rationing
Sharon Crosbie
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Core Services Committee 1992.
National Waiting Time Project
1998. Changes to Health Lexicon
By September 2006 - 24,000
patients were refused First
Specialist Assessment & 22,000
removed from waiting lists.
Result Increasing unmet need.
The Press, Christchurch. 25th August 1998
‘New booking system a scam, says surgeon’
His waiting list stretches to about 150 people
© Fairfax Media
Reproduced with permission 9th October 2015
National Waiting Time Project
Orwellian Speak
When they say – “The
waiting list is only four
month long”.
 They mean – “If your
operation won’t be done
within four months we
won’t have you on our
waiting list”.
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Neologist; Dystopionist
Acceptance Pipeline for Public Hospital Elective Healthcare
Disease
Reservoir of Community Need
Reservoir of Community Need
Community Expectations
GP Expectations
‘Health Pathways’
Clinical/Financial Priority Thresholds
The hateful metaphor
“..... altering the
trajectory of demand”
National Waiting Time Standards
First Specialist Assessment
Accepted for Treatment
How much unmet need for elective surgery is there?
Apart from adults who
get surgery each year: Another 280,000/yr
told they need surgery
 Of these:170,000 aren’t
recorded anywhere
 Survey criticized as
biased by Minister of
Health.
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RACS Conference – 25th June 2003
CCH Trust Formed – 29th July 2004
Major Concepts
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Canterbury-wide access for some patients who
can’t access secondary elective health care.
Only two full-time paid employees.
All doctors, nurses, anaesthetists, legal,
businesses, etc donated pro bono.
Community volunteerism for other jobs &
services.
Totally funded by public donations.
R. Hadlee Eleven
Hagley Park Events
Sweet Adelines
Mount Pleasant BC
St Andrew’s College
Cust Charity Bike Ride
349 Harewood Road Purchased
15th August 2005
Andrew Sutherland, President RACS
Opened original East Wing 12th October 2007
Colonoscopy 1795
Who gets to be a patient?
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Can’t access public health care.
Condition affecting quality of life or
employment.
Can’t afford private care; no health
insurance; don’t qualify for ACC.
Signed declarations of qualification.
Objectives: Timely &
High Quality Treatment
1.
2.
3.
More Humane
 The ‘Dear John Letter’
 Serious feelings of ‘anger;
abandonment & loss of hope’.
More Cost-Effective
 Less complications
 Quicker return to work, etc.
Investment pays fiscal dividends
(Reeves A et al. Global Health 2013;9:43).
Clinical Day Services Offered
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Groin/Abdo Hernias
Haemorrhoids
Varicose Veins
Cataracts/Squint
Dental/Oral Surgery
Carpal Tunnel &
Dupuytren’s
Colonoscopy
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Women's health
sterilizations, etc
Orthopaedics upper &
lower limb
Podiatrics
Counselling/Psych
List alters to respond to
changes in unmet need
& resource availability.
Clinical & Administrative Staff Composition
of Charity Hospital by 31st December 2014
Staff Volunteers
Numbers Who
Ever Worked Since
2005
Numbers Who
Worked In 2014
Nurses
101
42
Anaesthetists
31
18
Physicians
11
0
Surgeons
56
24
Dentist/Dental Nurses
34/26
12/14
Counsellors/Psychologists
63
5
Technicians
14
5
Non-Medical
126
58
Part Time Employees
5
3
Full Time Employee
4
1
Numbers of Outpatient Appointments, Surgical Procedures
& Counselling Sessions by 31st December 2014
Calender
Year
2005 2008 2009 2010 2011 2012 2013
-2007
2014
Initial
Appointments
35
199
375
405
290
206
350
361
Follow-up
Appointments
22
125
221
173
346
193
216
289
Total Number of
All Treatments
22
228
368
242
1578 1023 1396
1201
Setup & Average Annual
Running Costs ($NZ)
Setup Cost All 3 Buildings - $4.5 million
 Annual Running Costs - $680,000
 All met by public donations, bequests &
special fundraising activities.
 82% goes on direct patient treatment costs.
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Tribute To The Volunteers
Other Groups Addressing Unmet Need
Examples
ARCH Directors
Auckland Regional
Charity Hospital.
 Taranaki Community
Health Trust.
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www.aucklandcharityhospital.org
National Studies of Unmet Need for
General Secondary Healthcare Services
Canada & USA
Italy
Thailand
Sierra Leone
Government to measure unmet 2ry
healthcare need through GPs practices
Dr Jonathon Coleman
TV3 The Nation 24/10/15
Others are joining in: e.g.
Canterbury DHB Audit
The Press 10th June 2015
STAGE 1: Pilot Study of Methods to Measure
Unmet Secondary Healthcare Need
Investigators
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A Prof Phil Bagshaw *†
Dr Sue Bagshaw *†
Prof Chris Frampton *
Prof Robin Gauld **
Dr Terri Green §
Prof Andrew Hornblow §
Dr Ben Hudson *
Dr Antony Raymont ¶
Prof Ann Richardson §
Prof Les Toop *
Mr Carl Shaw †
Study Arms
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Auckland & ChCh PHOs
GP prospective clinical
database case recording
Balanced population
sampling by:
* Face-to-face interviews
* Telephone interviews
* Web-based survey
of Otago, ChCh; ** University of Otago, Dunedin; § University of Canterbury;
¶ Auckland Independent Heath Researcher; † Canterbury Charity Hospital Trust, ChCh
* University
Progress Report
Funded by: CMRF; ASMS; HM Trust;
RTATC Trust; Anon Trust; CCH Trust.
 3 Population Survey Arms: Research First
 Status: 3 Survey Arms underway
 Timeline: Survey Arms completed by end
2015; GP Arm completed by March 2016.
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STAGE 2: Independent Biennial Assessment of
Unmet Secondary Healthcare Need with Public
Reporting Processes
Bartman
Gauld et al NZMJ 2014;127:63-7
We The Medical Profession Have Let The
Public Down
Questions for NZ Medical Colleges
What are their official positions on unmet
secondary healthcare need?
 What do they intend to do about it?
 Do they support an independent, robust
system for its regular assessment and public
reporting?
 Thank you ASMS for your support
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John Donne (1572 - 1631)
Why bother? - Devotions upon Emergent Occasions; Meditation XVII
"No man is an Island, entire
of itself; every man is a piece
of the Continent, a part of the
main; ……… any mans death
diminishes me, because I am
involved in Mankind; And
therefore never send to know
for whom the bell tolls; It
tolls for thee."