Topic Papers on Health
Papers are available as MS Word [for Windows] "doc" or Adobe Acrobat "pdf" files.
- [October 2007]: The government and local health officials repeatedly deny we have too many managers, so how many do we actually have? The TDHB General Manager Human Resources, in a report to the Hospital Advisory Committee [295.1] on 30th May 2006 gave the "Skill Mix at April 2006" for the TDHB as Medical 9%, Nurses 45%, Allied Health 17%, Non-Health Support 8%, Management/Admin 21% (ie over 2.3 admin staff for each employed doctor!) [Ref: www.tdhb.org.nz/board/HAC%20Minutes%2020060530.pdf].
• The TDHB Annual Report lists 1560 employees. 21% of 1560 = 328 Managers & Admin staff
• Tony Ryall (National's health spokesperson) obtained the following figures under the Official Information Act:
| DHB | Management
& Admin FTE | Medical FTE | Admin:Doc ratio |
| Taranaki | 296 | 94 | 3.1 |
| Wanganui | 196 | 73 | 2.6 |
| all DHBs | 9804 | 5683 | 1.2 |
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• The Taranaki Daily News of 3rd Dec 2007 gives a figure of 246 Managers
• I have made a list of all TDHB management positions I could find (excluding P.A.s and clerical staff and excluding PHO management), the list is now 114 actual Managers.
- see Management.doc [34KB] or Management.pdf [86.5KB]
What is most upsetting about these numbers is that one third of the salary of just one of the hundreds of unnecessary managers would pay for all the Medical Officer retention proposals rejected outright by management and we would have much less difficulty recruiting and retaining these doctors!!
- [July 2007]: Public Deputation to the Taranaki District Health Board (TDHB) on the
Provision of adequate lower-level Secondary medical services in South Taranaki. The minimum medical staff for a viable in-patient service including monitored beds has not been maintained so a more attractive position is proposed with a request to the Board to support this policy. This Deputation met with hostile management response inconsistent with the TDHB Mission statement of "Welcoming new ideas".
- see Abstract [17.6KB] or SthTaranakiDeputation.pdf [62.6KB].
- [May 2007]: Primary Heath Issues in New Zealand - politicians and bureaucrats are essentially speeding up the exodus of NZ trained doctors while doing nothing to retain and recognise the value of those left. I offer some solutions to current PHO, ethnicity and retention issues.
- see Health2007.doc [56KB] or Health2007.pdf [53KB].
- [July 2005]: The Medical Reference Group of the Health Workforce Advisory Committee has got it all wrong and produced a very political document that if implemented will see even fewer NZ trained GPs working in New Zealand - see Medical Workforce in NZ.
- [June 2004]: The Primary Health Crisis in South Taranaki paper.
- see PrimaryCrisis.doc [41KB] or PrimaryCrisis.pdf. [42KB]
- Because of political and Health Board failure to understand that retention is far more important than recruitment, by mid 2007 the GP:population ratio for South Taranaki had become the lowest in the country at 41.5 GPs per 100,000 population and by March 2008 another three had left giving an incredibly low GP ratio of 30/100,000. All GP workforce policies to date have predictably sped up this loss.
- [April 2003]: Rural Primary Health Paper - comment to politicians from a South Taranaki GP
- see RuralGP.
- [June 2003, updated Sept 2004]: IPAs & PHOs - a brief note on capitation & control.
- See IPAs & PHOs.
Practice Newsletter Archives
Political Aspects
- [June 2004]: The National Primary Medical Care Survey report showing the failure of capitated practices to deliver (compared to non-capitated practices).
- [July 2004]: Minister of Health personal intellectual response to my PHO critique!
- [August 2004]: Letter to Editor South Taranaki STAR, 12/08/04
- [August 2004]: My reply to Annette King about PHOs
Acrobat version [for printing] DearAnnetteKing.pdf [28KB].
- [Nov 2004]:The Hawera GP appeal against the failure of TDHB to recognise us as rural TheChairman.doc [MS Word -30KB] or TheChairman.pdf [Adobe Acrobat -21KB].
- 2009 brings evidence from both the OECD and the Ministerial Review Group "Meeting the Challenge" report [aka the "Horn Report" after the Group Chairman Murray Horn] that PHOs have been a huge waste of money, increased the demand for limited GP services and not achieved any stated goal - except reducing GP fees. Of course if non-PHO GPs had similar patient subsidies, they would have extremely low fees as they don't have to support the additional bureaucracy.
[April 2009]: "The PHOs should either be eliminated as an unnecessary new bureaucratic layer or else their role and obligations must be more clearly defined" see
OECD Economic Survey of New Zealand (2009) [Adobe Acrobat -322KB]. and
[31 July 2009]: "While we accept the logic of the OECD recommendation above we consider that PHOs should first be given the opportunity and encouragement to help develop new models of care.....Unless PHOs can do significantly more in the direction suggested above, questions need to be asked about the extent to which they are playing the role that they should be.....DHBs should not be restricted to dealing with PHOs if direct agreements with others, like NGOs [and other providers like private non-PHO GPs], can achieve the same ends.....Left unchanged, the current DHB- and PHO-based model of health delivery is likely to rapidly generate an unsustainable tension between the community’s expectations of the public health service and the community’s ability to finance those expectations." see
MRG Report "Meeting the Challenge" [Adobe Acrobat -250KB].
I am happy to have any feedback on any of these topics (see e-mail options on the right).
Dr Keith Blayney
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