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    • Media Release: DHB Election brings living wage a step closer
      • 14 October 2013 The DHB election has delivered a strong mandate for a living wage for all DHB funded workers, said Labour DHB Board member David Choat who was re-elected to the Board yesterday. “The living wage was raised at every candidate meeting and is clearly important in respecting the important work done by many health workers in delivering quality health services. “I am pleased to be elected with fellow living wage supporters Sue Kedgley, Chris Laidlaw, Helene Ritchie and Judith Aitken. “The Government need to listen to people in Wellington, Porirua and Kapiti who have sent a clear message that cuts in health services and poverty wages for health workers are unacceptable. “I will be working with my other newly elected Board members to ensure that the Government restores cuts to much needed health services and funds the DHB to pay workers a living wage.”

    • Media Release: New Interim Chief Executive will face legacy of underfunding
      • 5 September 2013 Capital & Coast District Health Board member David Choat says he wishes new interim Chief Executive Debbie Chin well but warns that the financial problems she will face will be at least as great as those that confronted former CEOs Ken Whelan and Mary Bonner. Ms Chin’s appointment was announced this afternoon. “This government has consistently refused to fund health adequately, and the result is increasingly impossible decisions for Boards and management.” “The reference to “financial challenges” and an “ambitious” Annual Plan in Ms Chin’s announcement is standard public relations code for tough times to come.” “I support Ms Chin’s appointment to this interim role. Her roles to date make her uniquely-placed to step into the position and ‘hit the ground running’. But anyone who thinks we can run an effective hospital and fund safe and effective service for Porirua, Kapiti and Wellington without a better funding settlement from the government is kidding themselves.” David Choat is speaking as an individual Board member and not on behalf of the Board as a whole. He was elected to the Board in 2010 and is currently standing for re-election to the Board as the candidate for the Labour Party.

    • The tyranny of low expectations
      • John Key was elected in 2008 on a platform of being ‘ambitious for New Zealand’. But a central element of his government’s political project has been about systematically reducing New Zealander’s aspiration, lowering our sights, and taking away our hope for a better tomorrow. This, we are told, is ‘as good as it gets’. Only […]

    • The tyranny of low expectations
      • Source: Treasury, http://www.treasury.govt.nz/downloads/pdfs/b13-info/b13-2659847.pdf, Figure 4 John Key was elected in 2008 on a platform of being ‘ambitious for New Zealand’. But a central element of his government’s political project has been about systematically reducing New Zealander’s aspiration, lowering our sights, and taking away our hope for a better tomorrow. This, we are told, is ‘as good as it gets’. Only a fool would claim that they can make life any better. And the media commentariat and the financial establishment will line up to ridicule anyone who steps out of line. We need to reject this. The politics of austerity haven’t been handed down as holy writ. They represent a particular set of choices, priorities and interests. And the interests they serve are not those of the ordinary people of New Zealand. This is clearly the case in Health. The graph above is taken from a Four-Year Plan for Health submitted by Tony Ryall at the end of last year, and published on the Treasury website in July. It clearly shows the levels of additional funding put into the health sector by the Fifth Labour Government — increases peaked at over a billion dollars per annum in 2006/7 before settling into what was seen as a more modest business-as-usual rate of increase of around $700 million a year, or about 6-7% more funding each year. National on the other hand has put in place increases of only about $350-$400 million a year, or 2-3%. This is barely enough to keep up with inflation pressures, let alone the challenges of an ageing population. No wonder our DHBs are under pressure, and faced with unpalatable and often short-sighted decisions. What’s more, the settlement for this term and — if National is re-elected — next term as well is actually more dismal, more meager than at the worst point of the global financial crisis. It seems that National is determined to starve the Health system until it reaches crisis-point. Or until someone pushes back. We don’t have to accept this. We shouldn’t accept this. People in this district and around the country need to stand up and tell the government that we demand adequate health funding.  One way you can do that is by giving your #1 vote in this month’s Capital & Coast DHB election to me as a voice for proper funding and against austerity.

    • Notes from Hospital Advisory Committee, 26 July 2013
      • Each District Health Board has advisory committees to assist in the governance role. I’m a member of the Hospital Advisory Committee (HAC), which oversees the ‘hospital arm’ of the DHB’s operations – the services we provide directly, rather than those we fund in the community. Here are a few notes from Capital & Coast’s Hospital Advisory […]

    • Notes from Hospital Advisory Committee, 26 July 2013
      • Each District Health Board has advisory committees to assist in the governance role. I’m a member of the Hospital Advisory Committee (HAC), which oversees the ‘hospital arm’ of the DHB’s operations – the services we provide directly, rather than those we fund in the community. Here are a few notes from Capital & Coast’s Hospital Advisory Committee meeting for August 2013, which was held today. This was the second-to-last HAC meeting before the 2013 District Health Board elections, which finish on 12 October. 6-Hour Target for Waiting at Emergency Department This is a big priority for Health Minister Tony Ryall, and one that our DHB has struggled with. It is consequently a big topic just about every month at HAC. This month the HAC Chair commented on a report that had stated that there may be a risk that we haven’t got the resources to do what we have to do to meet the 6-Hour Target. He noted that this was the first time he’d seen that. Staff commented that they would be reporting to us further on this, and that the additional resources, if needed, would be in project management rather than frontline staff (that’s my characterisation of the comments rather than a direct quote). Safety Culture – Lessons from Mid Staffordshire We had a presentation on the Mid Staffordshire patient care scandal in the UK and how Capital & Coast can ensure it doesn’t fall into a similar pattern. (This was scheduled as ‘public excluded’ but I queried this and there was general agreement that it should be discussed in public.) The DHB is currently undertaking a staff safety culture survey, and the findings from that will be interesting. There is also some work being done on articulating ‘values-based behaviour.’ But perhaps the most exciting development is a renewed impetus behind Consumer Councils. Apparently there are seven of these currently operating or being established. There is one at Kenepuru, one for Mental Health, and one for Child Health is currently in process. An umbrella Consumer Council is being set up to coordinate their activities. This could be a really valuable development, and I’d be really keen for the Board to meet with these folk in the future and get a perspective from them directly. The ‘3DHB Juggernaut’ I continue to be concerned about the push toward more and more link-ups between Capital & Coast, Hutt and Wairarapa, particularly how it seems to be progressing in an ‘under the radar’ and apparently unplanned way. The latest development is coordinating HAC meeting between the 3 boards, including a ‘joint’ meeting each month alongside the separate ones. Meeting venues would rotate between the three DHBs. (A similar change would occur with our Finance Risk & Audit Committees.) I spoke against this. I feel this is an ad hoc change in the ‘dying days’ of the current Board and it would be better to wait to have the new Board consider this idea (in a wider context) after the upcoming election. But the Committee voted to endorse this proposal to the full board, with only Helene Ritchie and I opposing, and Margaret Faulkner abstaining.

    • DHB election a choice between cuts and quality health services
      • Media release 17 August 2013 There are 23 candidates seeking election to the Capital and Coast District Health Board it was announced yesterday. Current Capital and Coast DHB member and Labour candidate David Choat said, “In the upcoming DHB elections, the public has a choice between candidates who will advocate for increased funding and better […]

    • DHB election a choice between cuts and quality health services
      • Media release 17 August 2013 There are 23 candidates seeking election to the Capital and Coast District Health Board it was announced yesterday. Current Capital and Coast DHB member and Labour candidate David Choat said, “In the upcoming DHB elections, the public has a choice between candidates who will advocate for increased funding and better services in response to the destructive cuts imposed by Government, and those that refuse to confront the impact of funding cuts.” “If re-elected, I wil continue to advocate that the Capital and Coast DHB must send a strong message to the Government: without funding increases, more important health services wil be lost. All the warning signs are present, we have gone through three Chief Executives in only seven years, important services like Newtown Union Health Service have been cut back, and access to your local doctor is the worst in New Zealand when compared with other large DHBs.” Choat said the long list of candidates announced yesterday, with some relatively well-known names, was an indication of rising awareness about the importance of strong DHB governance generally, and particularly in this District with the challenges it faces. ENDS

    • More progress on the issue of access to primary care
      • Last month I put out a media release about new evidence that showed that access to primary health care in the ‘capital and coast’ (Wellington, Porirua, Kapiti) district was a lot worse than in other DHB districts. I raised the issue at the Board table and (as I reported) there was agreement to have a […]

    • More progress on the issue of access to primary care
      • Last month I put out a media release about new evidence that showed that access to primary health care in the ‘capital and coast’ (Wellington, Porirua, Kapiti) district was a lot worse than in other DHB districts. I raised the issue at the Board table and (as I reported) there was agreement to have a paper produced for today’s Community and Public Health Advisory Committee. The paper was discussed as part of a session on primary care, including representatives from all of the region’s Public Health Organisations (PHOs). And I’m happy to report a positive outcome. I put the case that Capital & Coast DHB really does have reason to be concerned about access in our district, citing not just the NZ Health Survey covered in the staff paper but also the Quality of Life survey and our PHO enrolment rates (I’ll post more about these in the future.) The PHO folk at the meeting had seemed to have an open mind about the issue and one indicated that the staff paper would be a useful resource. The committee chair agreed that there should be ongoing work on this issue, focussing initially on trying to get a better handle on how we’re doing on primary care access. The other members and staff all seemed happy to go along with this. Now, I’m under no illusions. We’re a long way from full acceptance that there’s a problem, let alone getting agreement on how to tackle it. There may be attempts to ‘push out’ the work on this, saying we should wait until the census data is out or somesuch. But I do think there’s been a positive shift here, and there’ll be further opportunities to keep the focus on this crucial issue.

    • Access and equity – how does New Zealand compare?
      • I’ve recently written a bit about health access concerns here in the Capital & Coast district. In this post I want to give some context for that by citing a few findings about how the New Zealand system as a whole performs. Last month, I – along with a bunch of other people including my […]

    • Access and equity – how does New Zealand compare?
      • I’ve recently written a bit about health access concerns here in the Capital & Coast district. In this post I want to give some context for that by citing a few findings about how the New Zealand system as a whole performs. Last month, I – along with a bunch of other people including my Board colleague Judith Aitken –  went along to a IGPS/IPANZ seminar from Dunedin health academic Professor Robin Gauld.* Professor Gauld’s seminar was called “The Governance of the Health Care System” and covered a wide range of issues, including the DHB governance model. I didn’t buy everything he said, and might write something up about that at a later stage. (His full set of presentation slides can be found here.) But in this post I want to focus on one particular part of the presentation, where Professor Gauld looked at how New Zealand’s health system compared to other countries. (This was based on an paper he had co-authored for the journal Health Policy.) As you can see from the slide above, New Zealand did pretty well overall but was weakest on access and equity. He then showed two graphs to reinforce this point. This slide focuses on cost barriers and shows we do a lot worse than the UK or Sweden but are probably better than Australia, and definitely a lot better than the notorious US health system. Whereas this graph, on waits to see a specialist, shows us as pretty clearly the worst of all the countries depicted. It seem, in short, that not only does Capital & Coast seem to have some particular problems, but this is an area where our health system as a whole needs to do a lot better. Worth remembering when somebody tries to tell you that the top priority in health policy is saving money!   * Sort of. Actually, weather problems meant that Professor Gauld couldn’t make it to Wellington, but the seminar went ahead anyway with him delivering his presentation and answering questions by skype. It worked pretty well, all things considered, and was certainly better than cancelling!

    • Budget places Capital and Coast services at risk with multi-million shortfall
      • “Health Minister Tony Ryall has again failed to invest adequately in our nation’s health with a Budget that will see Capital and Coast District Health Board continue to struggle,” said David Choat, Capital and Coast DHB member. “We have perhaps the most precarious financial position of any large DHB and have been forced to make services cuts for longer than most. Our DHB is likely to be particularly hard hit by this latest round of underfunding.” “Dr Bill Rosenberg, economist for the Council of Trade Unions, has for a number of years now been tracking health funding against what is needed to keep pace with rising costs and population changes. His conservative estimate this week was that DHBs needed a 3.2% funding increase in today’s Budget just to stand still – let alone recover ground after four years of funding shortfalls. “Capital and Coast received $644 million in Crown funding to provide services for our district this year. On the basis of Dr Rosenberg’s figures, we would need another $21.5 million just to keep pace with an ageing population and rising costs. “Yet Budget documents reveal that our increase will be only $17.5 million. This is, at best, $3 million short of that minimum threshold. Moreover, around $4 million of that additional funding is tagged to particular initiatives and programmes that will bring their own additional costs, so the true shortfall could be as much as $7 million. “That is simply not good enough. The government says times are getting better, but it is still placing pressures on District Health Boards that seem calculated to force them to make further cuts to health services for vulnerable populations. We should be reinvesting in services that have already been cut in places like Newtown and Porirua, not making further reductions. David Choat is speaking as an individual Board member and not on behalf of the Board as a whole. He was elected to the Board in 2010 and is standing for re-election to the Board this year as the candidate for the Labour Party.

    • A small victory on the issue of access to primary care
      • Earlier this week I highlighted some Ministry of Health data about Capital & Coast doing worse than other DHBs in terms of people experienced unmet need for primary health care. I said I’d raise the issue at today’s Board meeting. I did, and I am pleased to say that my request met with some success, […]

    • A small victory on the issue of access to primary care
      • Earlier this week I highlighted some Ministry of Health data about Capital & Coast doing worse than other DHBs in terms of people experienced unmet need for primary health care. I said I’d raise the issue at today’s Board meeting. I did, and I am pleased to say that my request met with some success, as NZ Doctor has reported: Capital’s board faces up to primary care access problem Virginia McMillan Capital & Coast DHB’s “Care Not Cuts” board member David Choat today pushed an agenda on access to primary care. Although it wasn’t a “road to Damascus” moment, Mr Choat says at today’s board meeting he turned the attention of fellow members to local people’s comparatively poor access to primary care. The matter will now be researched in a report by DHB staff to a further meeting next month. Presenting a summary from the 2011/12 New Zealand Health Survey, Mr Choat says he argued access is of concern and the board needs to act to improve it. Part of the problem lies in funding cuts made by the board in primary care, he says. “Some of it is ensuring there is sufficient funding to support services for hard-to-reach and vulnerable populations.” The board needs to actively seek to support general practice and PHOs that have insufficient staff. The difficulty of getting enrolled or booking an appointment in the DHB’s area is notable and taken for granted by many people. But it’s not the way things are elsewhere in the country, Mr Choat says. A paper will be coming to the June meeting of the Board’s Community and Public Health Advisory Committee (CPHAC), on 17 June. The focus will be on looking at the Ministry’s survey data and putting it in ‘context’. There was some indications that this may involve some attempt to minimise the seriousness of the issue by pointing to things such as that Capital & Coast also have a high rate of primary care use. (Although that doesn’t really add up.) My Board colleagues Judith Aitken and Helene  Ritchie pressed that the paper needed to go further that and present an Action Plan for dealing with the issue of primary care access. I agree that this is just a small step. Nevertheless, I’m pleased that the issue is being looked at, and, though I’m no longer a member of CPHAC, I’m definitely planning to attend and press for serious action to address this serious problem. The paper will be available earlier in the week of the meeting. I’ll circulate it then, and will be interested in any feedback and advice on what it says.

    • New figures show Capital and Coast DHB has worst access to health care
      • “New figures released by Ministry of Health show that Capital and Coast District Health Board has the worst access to primary health care of any of the major DHBs in the country,” said David Choat, Capital and Coast District Health Board member. “The figures show that underfunding is really impacting on service for people living in Wellington, Porirua and Kapiti.” The figures released by the Ministry of Health are based on the 2011/12 New Zealand Health Survey, which involved face-to-face interviews with more than 12,000 adults aged 15 years and over from throughout New Zealand. While Capital & Coast’s results for many of the indicators in the survey are comparable with the rest of the country, the district’s results for what the Ministry calls the ‘Barriers to Accessing Health Care’ category are significantly worse: Approximately a third (33%) of Capital and Coast residents had experienced unmet need for primary health care in the past 12 months, compared with just over a quarter (27%) for New Zealand as a whole; Capital & Coast’s rate of unmet need was worse than that of any of the other six large DHBs for whom results were reported (Waitemata, Auckland, Counties Manukau,Waikato, Canterbury and Southern); The population group most likely to experience unmet need in the Capital & Coast district was woman aged 15-24, 44% of whom had experienced unmet need; The most common form of unmet need was being unable to get appointment with a GP, nurse or other health care worker at their usual medical centre within 24 hours, – 21% of Capital and Coast residents had experienced this, compared with 15% for New Zealand as a whole.  Capital & Coast had the worst result of the large DHBs, with a rate twice as high as the best performing district, Waitemata (10%). “These findings show that people in our district are unable to access healthcare when they need it. The DHB needs to address this urgently.” “When people cannot access doctors, it is not only dangerous for them but the DHB also pays the price in avoidable hospital admissions and poor health outcomes. “I will be raising these poor results at the DHB Board meeting this Friday and requesting that the Board urgently address this. “The DHB needs to admit that we cannot cut any more and be upfront with the Minister of Health Tony Ryall that he cannot keep expecting the DHB to do more with less. The Government should use their upcoming budget to fund DHBs properly. “In 2010, the Chief Executive Ken Whelan left the DHB saying that he just could not cut any more; we are now seeing the dangerous impacts of this underfunding.” David Choat is speaking as an individual Board member and not on behalf of the Board as a whole. He was elected to the Board in 2010 and is standing for re-election to the Board this year as the candidate for the Labour Party.  Also available – Background Factsheet: 2011/12 New Zealand Health Survey results for Capital & Coast District Health Board on Barriers to Accessing Health Care

    • I’m standing for Labour
      • Following a recent official announcement, I can now confirm that I am going to stand for re-election to the Capital & Coast District Health Board in the upcoming elections in October, and this time I’m going to do so as the candidate for Labour Party. I’m really pleased about this, for a couple of reasons. […]

    • Hi!
      • Welcome to my website. My name is David Choat and I’m an elected member of the Capital and Coast District Health Board. My guiding principle as a board member is ‘Care not Cuts’. I’ve advocated consistently for a quality public health system and am concerned about the impact of Government cuts in the health sector. […]

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