Integrated health project finally presented
The integrated management group. Photo: Neil Wilson.
Supporters, opponents and the undecided heard more information and aired their views at the IMG-organised public meeting about the integrated health project last Monday night.
A crowd of about 270 people gathered, showing the extent of the community’s interest in the issue. Chairperson Kerry Marshall, the Mayor of Nelson, worked hard and generally maintained the cordial atmosphere but there was a degree of hostility at times.
IMG chair John Peters briefly presented the firm business case for the integrated facility. He explained that developing the proposed facility on the existing hospital site would be between $1.25 million and $2.9 million cheaper than the other two site options. Mr Peters also released some figures showing that the integrated facility would require a mortgage of about $4 million.
The business case made no assumption about receiving the proceeds of any sale of the medical centre. Mr Peters stressed that the business case would have to be “very robust” in order to convince a bank to lend the money that was required for the proposed 15-year term.
The anticipated results released at the meeting show that the trust that would own the integrated facility is expected to produce surpluses from year one. This is based on rental income, paid by Nelson Bays Primary Health, that starts at $545,000. Some other features of the plan were the retention of a GP service in Collingwood and the confirmation of the fact that some $2 million would have to be raised from what Mr Peters called “large national organisations”.
After the presentation the IMG, principally Mr Peters but other members as well, answered submitted questions. A public meeting held the previous week produced about 70 questions and the IMG had selected a range of them to answer in public. The rest will be answered later in writing, said Mr Peters.
Once the written questions had been addressed, Mr Marshall opened the meeting to questions from the floor. Some questions and some answers became quite discursive, straying into other aspects of the health integration debate, but the information was generally well received. Sporadic applause greeted some questions and contributions to the conversation.
In response to a question about recruitment, retention and after-hours emergency care, Dr Struan Clark replied: “These days GPs have a choice; we can’t get them to come here because of the after-hours care they have to provide. We need to be on the same site as the hospital to provide improved services.”
Samantha Eastman asked why integration here meant the integration of buildings rather than services. Dr Clark spoke about the necessity of having nurses already at the integrated hospital/rest home/medical centre so that, in the event of an emergency, a patient was able to go to a staffed facility and be cared for until the doctor arrived.
Phil Langford congratulated the IMG and said, as a former board member of the Joan Whiting Trust, he believed that the current integration proposal was the “best opportunity that Golden Bay will get to get the infrastructure and service delivery it needs for the future.”
Joan Fishley asked whether there was any chance that the integrated facility could spread out further on the hospital site. Mr Peters explained that there was additional land available if it was required.
Dick Wenzel asked to what extent any financial responsibility could come back on to the Golden Bay community in the event of the proposed trust’s failure. Mr Peters said that the $5 million that currently comes into the Bay in health services would continue to do so and that the rent received by the new trust would provide enough income.
“It says in the trust deed that, in the event of the trust no longer fulfilling its responsibility to provide a site for the provision of health services, the DHB has the right to take back the facility. That’s what we would do in the event of the failure of the trust. The community would not be responsible.”
Rudolf Samper said that at first he had been sceptical about the project but now he supported it. “We are in tough times, everybody knows that. It’s important not to waste anything. Let’s go for it.”
Jackie McGrath from the Nurses’ Union said that while her organisation was philosophically opposed to the PHO being the provider, they believed that integration was the best way forward.
Pauline Wilkens, a nurse at Joan Whiting, was concerned about the nett 4.3 full-time equivalent jobs that were to disappear in the business case. “No matter what the effficiencies are, you still need the same number of people to offer the same level of care,” she said.
John McKinlay, an expert on primary health and a Patons Rock homeowner and said, “I do not believe that you will increase the likelihood of getting GPs here with this plan,” and that he believed it would be “unwise to immediately proceed with the facility integration plan as currently proposed”. Mr McKinlay had six “fundamental concerns” with the IMG proposal: around how the necessary funds will be raised; the assumption that the proposal will save the Joan Whiting home; the level of community apprehension; the “managerial ethos” driving the project; the centralisation of services; and the absence of complementary and alternative healers.
Dr Clark explained that the complementary and alternative healers had been represented on the original steering group but they opted not to continue their involvement.
Mr Peters pointed to the involvement of community stakeholders in the process and the extent to which the concerns of the nurses had been allayed since they published them in The GB Weekly.
Later, IMG member Peter Burton said: “The IMG notes Mr McKinlay’s concerns but we believe that it is imperative to get on with this proposal for expanded primary health care that meets the needs of the residents of Golden Bay. The overall sentiment is that people are supportive. As a result of the amount of feedback we’ve had, more of the boxes are being ticked all the time. We will take all of Mr McKinlay’s comments and come back with answers to them.”
Hospital nurse manager Alexia Russell spoke about her long experience as a nurse in the Bay.
“It’s not just about bricks and mortar; unless we’re together it just doesn’t work. This is a great opportunity: I’m still excited about it – tired, but still excited. There are challenges, but that has never stopped Golden Bay before, having a dream and following it.”
MP Damien O’Connor said that he believed integration was the way to make the best use of health resources in the Bay. He commended the DHB for its efforts and noted that the Bay’s excellent health services ran on individual goodwill.
“That individual goodwill must be sustained by the structure you develop here,” he said.
Clem Randall also spoke in favour of the integration project and encouraged people who agreed with the project to stand up and show the IMG how much support they had. More than half the crowd stood.
After the meeting, Kotinga resident Henny Pemberton said that she felt there was an “air of inevitability” about the project now.
“I have been very interested in the issue because I have my mother in Joan Whiting so I’ve been working away at trying to save the home,” said Henny. “I find it inconceivable that the people we love might have to be moved out of the Bay. Instead of tussling over the issue and making it fail, we should put our energies into making it work as well as possible.”
Neil Wilson
