Cost cutting a stressed health system only drives up costs - and Health Commissioner Lester Levy knows that

I was an engineer before I became a doctor and I understand how systems work. I have been a senior clinician, the medical leader of a hospital, a pioneer in patient safety, I have sat on hospital executive teams, and advised the NZ government and the WHO on healthcare quality and patient safety.

Way back in the 1990’s we had already established the correlation between hospital bed occupancy (%) and efficiency of the whole system, as commonly measured by Average Length of Stay (LOS) of patients. When the system is optimally operating, patients are diagnosed and treated quickly, the right care is delivered to the right patient, errors are quickly identified and corrected, and patients recover from illness, injury and surgery more quickly. But when bed occupancy passes a critical threshold, chaos ensues.

Patients wait hours or days for proper diagnosis and treatment. Many times I have seen acute surgical patients starved day after day for surgery, only to have their case cancelled at short notice. Acute medical patients end up on surgical wards and many other locations because the medical wards are over-filled. The nurses don’t have the experience and knowledge to safely care for patients in the wrong specialty. The junior doctors find their patients are scattered across many wards and the consultant ward rounds take hours.

Communication is impaired, surveillance is compromised, care is inexpertly given, rates of medical error and adverse events rise rapidly and many patients suffer preventable complications that greatly extend the length and cost of their hospital stay.

I recall doing a system analysis to uncover the root causes of harm to a patient who was not seen by any doctor in an emergency department for more than six hours, while he slipped into septic shock from an infection already diagnosed by his GP. If he had been promptly assessed and treated with antibiotics, he would have recovered in a few days. But this patient spent 42 days on intensive care with multiple organ failure, kidney dialysis, and amputation of limbs - all completely preventable.

Many decades ago, we also had research evidence relating patient outcomes to the nurse-patient ratio. If nurses have to look after too many patients, then the rates of medical errors, patient falls, and adverse events rapidly increases. Hospital mortality rates rise.

Our current hospital system is way past this point, in perpetual crisis. What used to be a "winter crisis' is now present all year round. Thus, every decision to cut costs in terms of health infrastructure and safe staffing levels will greatly increase the average cost of patient care. The health system does not just depend on the ‘front line’ staff. Ancillary staff are an essential part of the system that takes care of patients. If you take away the people who clean the wards, change the sheets on patients’ beds, and stock the supply cupboards, then patient care is compromised further.

One day, in my hospital, all surgery stopped because the health board had run out of ECG 'dots' - the self-adhesive electrodes placed on patients' skin to monitoring the heart beat. We couldn't do safe anaesthesia without this essential patient monitor. Innumerable times, I have seen care cancelled or delayed because clinical supplies ran out. A competent and adequately staff management structure is critical to system performance. Any competent businessman would know that.

Even the Treasury officials, in advice to the incoming government, had identified that ‘productivity’ in the hospital system was falling: fewer discharged patients for the amount of funding and staffing allocated.

Our Health Commissioner, Professor Lester Levy is a medical doctor, a businessman, a professor of leadership, and has been the Chair of all three health boards in Auckland. He would have heard innumerable presentations from his chief executives about the very issues I am naming. He’s a smart man and he knows that his actions are driving a broken system deeper into crisis. He understands that cost cutting and sacking thousands of staff will actually increase costs and further damage the system. In the news media we see almost daily reports about the Health NZ budget blowout being worse and longer-lasting than planned.

So what is Professor Levy's motivation? If he was a man of integrity who actually cared about the public health system, how would we expect him to behave? Not by his disingenuous claims to protect the 'front line' of healthcare while finding new 'efficiencies'.