Ryall: do it or else

Written By: - Date published: 3:30 pm, November 25th, 2008 - 32 comments
Categories: health, national/act government - Tags:

Health Minister Tony Ryall’s first policy will be to impose maximum waiting times for hospital emergency departments. No word on extra funding for achieving those goals (the UK achievement in shortening waiting times that Ryall cites came with large health budget increases) or what will happen if they are not met.

Now, it’s great to shorten wait lists. Nobody, least of all the medical professionals, wants people to have to wait any longer than necessary and DHBs are continuously implementing new procedures to make gradual improvements across the range of their activities. But let’s be clear, Ryall’s policy is not a plan to shorten waiting times, it is just a demand that waiting times be shortened. Ryall used to spend most of his time making similar demands to health ministers but, now he is health minister, he’s not developing ways to shorten wait times, he’s just shifted who he is demanding results from. And what will he do if they don’t meet his demands? Will he cut funding? How will that make health providers more able to meet the medical needs of Kiwis?

We have a reasonable expectation that, after years of complaining, National/ACT will improve health outcomes even more than they improved under the Labour-led Governments. It is looking distressingly like Ryall has no plan to meet those expectations, and is already looking for someone else to blame.

But perhaps that is the long game. The word around town is that Ryall has one clear, overriding objective in the health portfolio – cut spending. A failure to meet targets will be just the excuse he needs.

32 comments on “Ryall: do it or else ”

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  1. higherstandard 1
    25 November 2008 at 3:39 pm

    Bah

    Fantasy ! The best way to start shortening waiting times in EDs is to refuse to treat anything that is not an emergency – of course if we start doing that there’ll be all hell to pay.

    I expect Ryall will join the long list of useless twats we have had as Minister of Health in recent times and not make any of the changes that would really make a difference.

  2. bobo 2
    25 November 2008 at 3:41 pm

    That’s all the over stretched A&E staff need.., some pencil neck politician banging his fist on the table saying there are no problems only solutions.. The biggest problem is that A&E is used by people who can’t afford a GP visit and it’s likely to get worse if National allow GP’s to charge more or cut gov subsidies.

  3. DeeDub 3
    25 November 2008 at 3:42 pm

    Ryall was the guy who said the cost of a GP visit isn’t ‘uppermost’ in the mind of most NZers, right?

    The guy’s a total twat.

    Row faster everyone . . . or else!

  4. gingercrush 4
    25 November 2008 at 3:44 pm

    I don’t for a second believe health will improve much if at all under National. But where is the evidence that health improved when Labour was in power? Successful at deflecting most right-wing attacks sure. Making waiting lists look good by dumping thousands of people off them. That isn’t improving health.

    The reason Labour was so successful in the area of health. Was not that it improved much if at all. Its not because they spent billions. National 1990-1999 also spent billions on health. The reason Labour was successful because they had the smartest Labour MP for years as its spokeperson meaning Annette King was able to essentially make health a non-issue.

  5. Billy 5
    25 November 2008 at 3:58 pm

    The word around town is that Ryall has one clear, overriding objective in the health portfolio…

    The word around town! The word around town! Is that all ya got? The word around town is that I am hung like a rogue baboon. The word around town is that the moon is made of beef jerky. The word around town is that randall sucks cold farts from dead chickens.

    [lprent: Billy – just out of interest – does that include the interesting facial problems and strange arse? ]

  6. Kevin Welsh 6
    25 November 2008 at 4:05 pm

    As someone who has experienced A&E, my sympathies are with the staff that work in these departments. Chronology of events: (Times are after admittance)

    1. Broke leg playing football. Friends took me to A&E.
    2. Filled in appropriate form and wheeled to examination room. 10 minutes.
    3. Examined by junior doctor who confimed leg was broke. 20 minutes.
    4. Examined by Orthopaedic Specialist to make sure no structural problems. 50 minutes
    5. Leg X-Rayed. 3.5 bloody hours. This was where the bottle neck-was. No dedicated X-Ray facility for A&E. As radiology is probably the most understaffed/resourced sector of health, this was the biggest part of waiting. X-Ray procedure took 10 minutes.
    6. Leg set in cast and checked out of hospital. 4.5 hours.

    The staff I dealt with were friendly, sympathetic and helpful and incredibly busy, but at no time was I made to feel like I was an inconvenience. With the resources they had, they performed as could be expected.

    I doubt whether Tony Ryall waving his finger would have made any difference to the speed at which I passed through the system (no pun intended).

    I look forward to seeing him on the receiving end in the house next year.

  7. gingercrush 7
    25 November 2008 at 4:09 pm

    Oh National will prove pathetic trying to deflect left-wing attacks on Health. National does do awful in health.The 90s saw so much reform over the years. Labour reformed the health system once at the start of their first term then left it alone. That undoubtedly helped.

    Ryall isn’t that impressive either. Health will be a bogey for National. Not because Labour did much better but just that Labour will be far more effective in opposition than National ever was for health.

  8. Steve Withers 8
    25 November 2008 at 4:22 pm

    National’s ‘media honeymoon’ with The NZ Herald began in 2004 and is still very much in progress.

    As for Tony Ryall, he’s a classic ‘kiss up / kick down’ party hack.

    All mouth and no ears. Arrogant as hell while declaring people a fraction as arrogant as himself to be unbearable – of course.

  9. QoT 9
    25 November 2008 at 4:24 pm

    I’m really just depressed at the prospect of rightwing fanboys screaming “SEE? National’s doing things to cut waiting lists!!!” with their usual blissful ignorance of the difference between self-destructive rhetoric and actual changes in service delivery and health outcomes.

  10. Ianmac 10
    25 November 2008 at 4:49 pm

    The huge increase in funding of Health over the last nine years has been in developing infrastructure: new hospitals, new theatres, increased staff numbers, significant wage increases for nurses/doctors, technology, medicines. Sadly the long-term benefit is now beginning to show in time for Ryall to take the credit. The waiting lists are a very tiny reflection of just how good our Health system is. I think our Public Health System is just fantastic.

  11. Tigger 11
    25 November 2008 at 5:01 pm

    Wow, seems like Ryall’s leadership strategy is to whip the horse until it dies. Way to go Tony.

  13. burt 13
    25 November 2008 at 5:23 pm

    Helen Clark could teach Ryall a thing or two about slashing health budgets from her past experience as minister of health. Perhaps A&E departments could be devolved to the community…. It worked sooooo well for Mental Health!

  14. Rex Widerstrom 14
    25 November 2008 at 5:31 pm

    Would this be the appropriate time to resurrect a tired old joke?

    Health Minister Tony Ryall today announced a bold new plan to shorten hospital queues. “All A&E staff will be issued – at significant expense, I might add – with tape measures,” the Minister explained. “They will ensure that in future, the people who form the queues that stretch through their departments, out the door and down several city blocks, will stand no more than 4 centimetres apart.

    “This wasteful slouching – especially by those on crutches – that’s been going on has seen gaps of up to a metre between patients. Or, was we like to call them, ‘applicants for client status’. This new four centimetre rule will have the immediate effect of shortening queues and will introduce added efficiencies in that those who opt to ‘discontinue their application process’, as we call it, will be that much closer to the hospital morgue”.

  15. Millsy 15
    25 November 2008 at 5:36 pm

    Let’s hope they dont bring back CHE’s and RHA’s and all sorts of nasty acronyms..

  16. northpaw 16
    25 November 2008 at 7:25 pm

    rex widerstrom,

    “…This new four centimetre rule will have the immediate effect of shortening queues and will introduce added efficiencies in that those who opt to ‘discontinue their application process’, as we call it, will be that much closer to the hospital morgue’.

    🙂

    BTW: did this joke of yours originate in the French health service.?

  17. higherstandard 17
    25 November 2008 at 7:27 pm

    Millsy one of the best things they could do would be to cull the numbers of DHBs and bring back something along the lines of the regional health authorities.

  18. Rex Widerstrom 18
    25 November 2008 at 9:34 pm

    northpaw: It’s a lengthy recitation of what was a very short “Two Ronnies” news headlines gag. I think it came right after “Police tonight are investigating the theft of several toilets from their station. At this point, they say they have nothing to go on”. 😀

  19. ak 19
    25 November 2008 at 9:35 pm

    HS: you mean forget about local accountability and democracy and head back to that debacle brought in by …who was it now…that’s right, that health expert name of Winston Peters. Got a link to that report that says how much “culling” DHBs would save? Any such report exist?

  20. TimeWarp 20
    25 November 2008 at 11:08 pm

    Issue identified immediately in the Herald when reporting on this – although as often the case, no analysis resulting:

    http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10544867

    The problem with ED delays actually stems from resource constraints elsewhere in the hospital system.

    National got elected on sloganeering – are they going to govern on it as well? It’s so bloody simplistic to think you can read DHB CEO’s the riot act and things will get better, when the problem isn’t just in ED management or resources but dependant on the entire hospital system.

    I’m sure the entire problem will be resolved by Monday….

  21. deemac 21
    25 November 2008 at 11:32 pm

    any manager worth their salt can achieve an arbitrary target – but at what cost? in the UK, the time limit on waiting times in A&E led to ambulances circling hospitals until they were allowed to deposit patients in the emergency room. Tough if the ambulance was needed for another emergency, but hey the target was met.

  22. TimeWarp 22
    25 November 2008 at 11:54 pm

    Exactly dee….. watch the Law of Unintended Consequences kick in.

    ED targets are hit, then elective surgery waiting lists go from 6 months to 2 years maybe.

  23. MacDoctor 23
    26 November 2008 at 12:26 am

    Without providing extra resources (namely doctors and nurses), Ryall is just blowing hot air. As Deemac points out, it is no problem to cook the system so that you meet the targets. Without the basic resources nothing will change.

    The irritating thing is, we know the correct staffing levels for ED as they have been really well-researched (1 doctor per patient per hour on average and 1 nurse FTE per 1000 patients per annum). We have known these figures for over 10 years. I have yet to see an emergency department staffed to these levels.

  24. bill brown 24
    26 November 2008 at 9:20 am

    At least his mates at the Hawke’s Bay DHB will be back in a job soon.

  25. Chris G 25
    26 November 2008 at 9:22 am

    Will this mean that down the track during question time and in statements to the media the Nats can parade “Waiting lists have been reduced under a National Government” Maybe even with a graph showing the difference from 2008 to 2009?

  26. Mr Magoo 26
    26 November 2008 at 9:57 am

    High Standards (for me, but not from) wrote: Fantasy ! The best way to start shortening waiting times in EDs is to refuse to treat anything that is not an emergency – of course if we start doing that there’ll be all hell to pay

    Yes there will. Many of those “non-emergencies” will become expensive emergencies later when those people don’t get treatment at all. Eventually people will just stop going and will wait to see what happens – leading to real, expensive emergencies.

    It is similar to heart attacks. They are ridiculously expensive to treat. Of course most of them would have been easily solved by “putting down the bloody fork”.

    But investing in anti-fork campaigns is seen in “nanny-state” by Nationalites. (or is that now Labourlites??)

    National’s plan is to have the severely under-funded ambulance at the bottom of the very high, man-made cliff. The cliff having a great big sign on it saying: “tax cuts this way”.

    If the fool is simultaneously running around with the “cut stick”, then things are about to get bad for the sick. About as bad as they were last time National did exactly the same thing.

    Let’s not forget how public departments react (or at least their admin) when idiotic and short sighted “targets” are given to them as a spin stunt. They game the system – because they have to to keep their jobs.

  27. Chris G 27
    26 November 2008 at 10:35 am

    “The best way to start shortening waiting times in EDs is to refuse to treat anything that is not an emergency”

    I agree that it would work, but I dont think its the best option.

    There is no substitute for a good healthy diet and lifestyle, if that is emphasised more a la Push Play ads.. That ultimately leads to: Healthier citizens, less ED waiting times.

    Furthermore, someone may have the stats showing the amount of ED lines ballooned by Alcohol related incidents? Are we willing to point the finger at our binge culture yet? I certainly am.

    In addressing these societal issues and hoping that it occurs at a policy level, no doubt I’m a ‘nanny stater’?

  28. higherstandard 28
    26 November 2008 at 10:51 am

    Chris

    Patient mix into EDs varies dependant on the time of week and year.

    As a very general rule of thumb weekends and Mondays are the busiest times and there tends to be spikes in numbers during flu season.

    For a fuller breakdown have a look at the link below.

    http://www.moh.govt.nz/moh.nsf/238fd5fb4fd051844c256669006aed57/dad5d4ad464df06bcc25714d00104db3?OpenDocument

  29. Mr Magoo 29
    26 November 2008 at 11:29 am

    “Without providing extra resources (namely doctors and nurses), Ryall is just blowing hot air.”

    Unfortunately this is not the case. As I mentioned in my previous post, changing the goal posts on public departments can cause massive shifts in how existing treatment and funding is applied. Most of the time towards inefficiency and harm when there is no real plan as such.

  30. Chris G 30
    26 November 2008 at 11:59 am

    hs,

    An interesting link, cheers.

    It seems that the most at 30% of ED patients came under the category of Injury/poisoning. Im not sure what that includes, but it sounds like a ‘preventable’ category.

    I would definately like to know the % of patients in for alcohol related reasons.

  31. lenore 31
    26 November 2008 at 10:44 pm

    So we can expect to magically have more available beds and staff to care for people. Unfortunately it will take alot more time than that. On the plus side for every negative side of the health system we hear in the media, there are positives. My daughter needed her skin to be checked out and we waited a week before seeing a specialist. likewise, I waited two weeks to see a specialist at our local hospital.

  32. TimeWarp 32
    26 November 2008 at 11:23 pm

    “The best way to start shortening waiting times in EDs is to refuse to treat anything that is not an emergency’

    We previously had that principle applied to the 111 emergency system. You could refer to the result as the Irena Asher syndrome.

    Granted, both sytems are abused. But you can’t take a one-dimensional approach (as Ryall seems hell-bent on doing) to solving the problem. You thereby invoke the Law of Unintended Consequences, with nasty results as occured with 111.

    To paraphrase, “it’s the system, stupid”. Only by looking at the overall system end-to-end can you solve the problem. Especially as the ED problems are created at other points in the hospital system (see my link in previous post above).

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