1. Canterbury Charity Hospital Trust & Unmet Need for Secondary Healthcare Services ASMS 27 th Annual Conference 20 th November 2015 Phil Bagshaw Chair, CCHT By the community; for the community

2. NZ Health Reforms & Healthcare Rationing Core Services Committee 1992. Core Services Committee 1992. National Waiting Time Project 1998. Changes to Health Lexicon 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. By September 2006 - 24,000 patients were refused First Specialist Assessment & 22,000 removed from waiting lists. Result Increasing unmet need. Result Increasing unmet need. Sharon Crosbie

3. The Press, Christchurch. 25 th August 1998 ‘ New booking system a scam, says surgeon’ His waiting list stretches to about 150 people © Fairfax Media Reproduced with permission 9 th October 2015

4. National Waiting Time Project Orwellian Speak When they say – “The waiting list is only four month long”. 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”. They mean – “If your operation won’t be done within four months we won’t have you on our waiting list”. Neologist; Dystopionist

5. Acceptance Pipeline for Public Hospital Elective Healthcare Reservoir of Community Need Community Expectations GP Expectations ‘Health Pathways’ First Specialist Assessment Clinical/Financial Priority Thresholds National Waiting Time Standards Accepted for Treatment Disease Reservoir of Community Need The hateful metaphor “..... altering the trajectory of demand”

6. 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. How much unmet need for elective surgery is there?

8. RACS Conference – 25 th June 2003

9. CCH Trust Formed – 29 th July 2004

10. Major Concepts Canterbury-wide access for some patients who can’t access secondary elective health care. Canterbury-wide access for some patients who can’t access secondary elective health care. Only two full-time paid employees. Only two full-time paid employees. All doctors, nurses, anaesthetists, legal, businesses, etc donated pro bono. All doctors, nurses, anaesthetists, legal, businesses, etc donated pro bono. Community volunteerism for other jobs & services. Community volunteerism for other jobs & services. Totally funded by public donations. Totally funded by public donations.

11. Mount Pleasant BC Sweet Adelines R. Hadlee Eleven Hagley Park Events St Andrew’s College Cust Charity Bike Ride

12. 349 Harewood Road Purchased 15 th August 2005

15. Andrew Sutherland, President RACS Opened original East Wing 12 th October 2007

18. Colonoscopy 1795

19. Who gets to be a patient?  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.

20. Objectives: Timely & High Quality Treatment 1. More Humane  The ‘Dear John Letter’  Serious feelings of ‘anger; abandonment & loss of hope’. 2. More Cost-Effective  Less complications  Quicker return to work, etc. 3. Investment pays fiscal dividends (Reeves A et al. Global Health 2013;9:43).

22. Clinical Day Services Offered Groin/Abdo Hernias Groin/Abdo Hernias Haemorrhoids Haemorrhoids Varicose Veins Varicose Veins Cataracts/Squint Cataracts/Squint Dental/Oral Surgery Dental/Oral Surgery Carpal Tunnel & Dupuytren’s Carpal Tunnel & Dupuytren’s Colonoscopy Colonoscopy Women's health sterilizations, etc Orthopaedics upper & lower limb Podiatrics Counselling/Psych List alters to respond to changes in unmet need & resource availability.

23. Staff Volunteers Numbers Who Ever Worked Since 2005 Numbers Who Worked In 2014 Nurses10142 Anaesthetists3118 Physicians110 Surgeons5624 Dentist/Dental Nurses34/2612/14 Counsellors/Psychologists635 Technicians145 Non-Medical12658 Part Time Employees53 Full Time Employee41 Clinical & Administrative Staff Composition of Charity Hospital by 31 st December 2014

24. Calender Year 2005 -2007 2008200920102011201220132014 Initial Appointments 35199375405290206350361 Follow-up Appointments 22125221173346193216289 Total Number of All Treatments 222283682421578102313961201 Numbers of Outpatient Appointments, Surgical Procedures & Counselling Sessions by 31 st December 2014

25. Setup & Average Annual Running Costs ($NZ) Setup Cost All 3 Buildings - $4.5 million Setup Cost All 3 Buildings - $4.5 million Annual Running Costs - $680,000 Annual Running Costs - $680,000 All met by public donations, bequests & special fundraising activities. All met by public donations, bequests & special fundraising activities. 82% goes on direct patient treatment costs. 82% goes on direct patient treatment costs.

26. Tribute To The Volunteers

27. Other Groups Addressing Unmet Need Examples Auckland Regional Charity Hospital. Taranaki Community Health Trust. ARCH Directors www.aucklandcharityhospital.org

28. National Studies of Unmet Need for General Secondary Healthcare Services Canada & USA ItalyThailand Sierra Leone

29. Government to measure unmet 2ry healthcare need through GPs practices Dr Jonathon Coleman The Press 10 th June 2015 TV3 The Nation 24/10/15 Others are joining in: e.g. Canterbury DHB Audit

30. STAGE 1: Pilot Study of Methods to Measure Unmet Secondary Healthcare Need Investigators 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 Auckland & ChCh PHOs GP prospective clinical database case recording Balanced population sampling by: * Face-to-face interviews * Telephone interviews * Web-based survey * University of Otago, ChCh; ** University of Otago, Dunedin; § University of Canterbury; ¶ Auckland Independent Heath Researcher; † Canterbury Charity Hospital Trust, ChCh

31. Progress Report Funded by: CMRF; ASMS; HM Trust; RTATC Trust; Anon Trust; CCH Trust. Funded by: CMRF; ASMS; HM Trust; RTATC Trust; Anon Trust; CCH Trust. 3 Population Survey Arms: Research First 3 Population Survey Arms: Research First Status: 3 Survey Arms underway Status: 3 Survey Arms underway Timeline: Survey Arms completed by end 2015; GP Arm completed by March 2016. Timeline: Survey Arms completed by end 2015; GP Arm completed by March 2016.

32. STAGE 2: Independent Biennial Assessment of Unmet Secondary Healthcare Need with Public Reporting Processes Gauld et al NZMJ 2014;127:63-7 Bartman

33. 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 are their official positions on unmet secondary healthcare need? What do they intend to do about it? What do they intend to do about it? Do they support an independent, robust system for its regular assessment and public reporting? Do they support an independent, robust system for its regular assessment and public reporting? Thank you ASMS for your support Thank you ASMS for your support

34. 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."