Teuila Fuatai
The Counties Manukau District Health Board (CMDHB) has hit headlines for all the wrong reasons lately. Its new Chair Vui Mark Gosche, sits down with Newsroom to talk through the state of affairs.
Described as a “significant refresh” for Auckland’s health services, Vui Mark Gosche’s appointment as chair of CMDHB raised a few eyebrows earlier this year.
The seasoned Labour man and long-serving unionist isn’t what everyone would consider new blood for the health sector, particularly following on from National’s previous appointment to the position – current Auckland Transport chair Dr Lester Levy.
With an impressive CV in corporate healthcare, and public and private sector management and advisory, Levy – who sat across all three Super-City Health Boards – was a markedly different character from Gosche.
However, Gosche, who met Newsroom at the South Auckland office of Vaka Tautua, is adamant that his local-boy background is exactly what Counties Manukau needs in its current state.
Vaka Tautua is the Pacific-focused health and social services provider he runs.
CMDHB riding rough
The DHB, which caters to some of the country’s most deprived Pacific and Māori communities, has been riding rough in the news since problems with its deteriorating buildings became public in March. More recently, fresh claims around a possible cashflow problem, and alleged inappropriate remuneration of one of its senior executives in the past, have caused more bad press.
“The problems are historical – we are not talking about people who are there now,” Gosche said of the claims around inappropriate remuneration.
Focus on deficiencies
“What I am focused on is that if there were deficiencies that were outlined in an internal audit report – have we closed those deficiencies, have we made sure that if there were things that we have done wrong or badly, that they’re not capable of happening again.”
That forward-thinking approach appears to underlie Gosche’s plans to chase bigger changes at DHB. Those changes, while long overdue, will inevitably involve convincing higher-ups in central Government for systemic shifts.
“I think the problem for an area like Counties Manukau is that we have got a lot of young people, but we have also got a lot of people who age prematurely. The [population-based] funding formula doesn’t recognise that.
In other parts of New Zealand, even in other parts of the northern region, you have got an ageing population that is healthy, but they will get the funding to reflect the fact that they have got an ageing population.
The Funding Formula
The population-based funding formula is used to determine the amount of funding each of the 20 DHBs receive. While it takes into account an area’s population, age and socio-economic status, the formula has also been criticised as outdated and unsuitable.
Gosche said, “What we have got is a growing population of ageing people, and then below that 65-year mark, you might find that the health of Pasifika and Māori in particular, at 55, is not good, and it requires the same level of care as an older person that is heading towards the end of their life.
“The funding formula does not recognise that parts of our population actually cost more to provide healthcare to because they’re actually hitting that level of poor health much younger than the rest of the population.”
Individualised approach
Gosche believes health practitioners who have a more “holistic” and family-orientated approach deserve more funding for their services, but admits getting change in a system not set up for it is hard.
“So much of what I see in health funding is this individualised approach. You might be a general practice and you get funded to do Well Child and smoking cessation, and something around diabetes and something with renal failure,” he said.
“All these strands of funding might actually be targeting the same person because you get two or three things impacting them, but how do you deal with the fact that they live in a family, and if you want to get behavioural change so that people care for themselves, know how to lead a healthier lifestyle and not turn up to hospital to be admitted because they are not controlling their long-term chronic illness?”
Behavioural change
Gosche, a former Housing Minister who is now Deputy Chair of the Housing NZ board, knows it is not a straightforward answer. However, he is a true believer that change, and improvement, is possible.
“You cannot just keep doing healthcare the way we are doing it and keep getting substandard results for big chunks of the population. Health cannot solve all the problems, but it can certainly work with other parts of the system … to get a change in the way we behave as a community.”
Discussions with “Wellington” last week indicate a good start to his tenure,” he says
“What they fund, and what the DHB fund – I think both parties are looking at what we can do better. It is not that you throw everything out and say, ‘it is not working,’ because that is not the case,” Gosche said.
“To a degree, a smallish part of the budget we get is discretionary -you have got hospitals to run, targets to meet and you’ve got all sorts of things that have to be delivered on. The amount of money that you get to try these new things is actually quite small. If you have got evidence of things that work, but it is on a really small scale, then it is a matter of how quickly you can scale them up and stop spending money on things that purport to do something.
“Saying that, I think Counties Manukau has very compelling arguments for having a good amount of money spent there – but I am not stupid enough to think that there are no other competing pressures there,” he added.
Teuila Fuatai covers social issues for Newsroom is an independent, New Zealand-based news and current affairs site. The above article, which appeared in their website on July 16, 2018 has been reproduced here under a Special Arrangement.
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Photo Caption:
Vui Mark Gosche
(Picture Supplied to Newsroom)
